Chung-Jen Lee

Low serum adiponectin level is associated with metabolic syndrome and is an independent marker of peripheral arterial stiffness in hypertensive patients

BackgroundAdiponectin has been implicated in metabolic syndrome (MetS) and arterial stiffness (AS). We aim to determine the relationship between serum adiponectin concentration as well as peripheral AS in hypertensive patients.MethodsFasting blood samples were obtained from 101 hypertensive patients. Brachial-ankle pulse wave velocity (baPWV) was measured with an automatic pulse wave analyzer. Serum adiponectin concentrations were determined by using an enzyme immunoassay kit. A baPWV >14.0xa0m/s was defined as high AS.ResultsMetS and high AS were present in 62.4 and 71.3% of the study population. Adiponectin was inversely associated with MetS and high AS (both Pxa0<xa00.001). Serum higher high-density lipoprotein cholesterol (HDL-C) (Pxa0=xa00.012), triglycerides (Pxa0=xa00.001), C-reactive protein (Pxa0<xa00.001), insulin (Pxa0=xa00.027), body weight (Pxa0=xa00.002), waist circumference (WC, Pxa0<xa00.001), body mass index (Pxa0=xa00.001) bilateral-baPWV (Pxa0<xa00.001), systolic blood pressure (SBP, Pxa0<xa00.001), diastolic blood pressure (DBP, Pxa0=xa00.012), pulse pressure (Pxa0=xa00.019), homeostasis model assessment of insulin resistance (HOMA1-IR (Pxa0=xa00.026) and HOMA2-IR (Pxa0=xa00.020)) and lower glomerular filtration rate (GFR, Pxa0=xa00.029) were significantly associated with high AS. Multivariate logistic regression analysis of the factors significantly associated with AS revealed that adiponectin [odds ratio: 0.932, 95% confidence interval (CI) 0.881–0.985, Pxa0=xa00.012], and SBP (odds ratio: 1.059, 95% CI 1.008–1.113, Pxa0=xa00.022) were the independent predictors of arterial stiffness in hypertensive patients. Subgroup analysis revealed that SBP (odds ratio: 1.126, 95% CI 1.024–1.237, Pxa0=xa00.014) and GFR (odds ratio: 0.858, 95% CI 0.739–0.996, Pxa0=xa00.043) were the independent predictors of arterial stiffness in hypertensive patients without MetS; adiponectin (odds ratio: 0.909, 95% CI 0.931–0.996, Pxa0=xa00.040) was the independent predictor of arterial stiffness in hypertensive patients with MetS.ConclusionsHypoadiponectinemia has positive association with MetS and peripheral AS in hypertensive patients.

High serum resistin levels are associated with peripheral artery disease in the hypertensive patients

BackgroundHypertension is a risk factor for peripheral arterial disease (PAD). Subjects with PAD are at increased risk of future cardiovascular (CV) events. Resistin is involved in the pathological processes of CV diseases. The aim of this study is to investigate whether resistin level is correlated with PAD in hypertensive patients.MethodsOne hundred and twenty-four hypertensive patients were enrolled in this study. Ankle-brachial index (ABI) values were measured using the automated oscillometric method. An ABI valueu2009<u20090.9 defined the low ABI group. Anthropometric analysis with waist circumference and body mass index, and fasting serum levels of blood urea nitrogen, creatinine, glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total calcium, phosphorus, and high-sensitivity C-reactive protein (hs-CRP) were measured using standard enzymatic automated methods. Serum levels of human resistin were determined using a commercially available enzyme immunoassay.ResultsEighteen hypertensive patients (14.5%) were included in the low ABI group. Hypertensive patients in the low ABI group were older (pu2009=u20090.043) and had higher serum creatinine (pu2009<u20090.001), high-sensitivity C-reactive protein (hs-CRP; pu2009=u20090.013), and resistin (pu2009<u20090.001) levels but a lower estimated glomerular filtration rate (pu2009=u20090.002) than patients in the normal ABI group. After the adjustment for factors that were significantly associated with PAD on multivariate logistic regression analysis, serum resistin (odds ratio [OR], 1.176; 95% confidence interval [CI], 1.028–1.345; pu2009=u20090.018) was also an independent predictor of PAD in hypertensive patients.ConclusionsA high serum resistin level is an independent predictor of PAD in hypertensive patients.

Serum resistin as an independent marker of aortic stiffness in patients with coronary artery disease

Background Subjects with higher carotid–femoral pulse wave velocity (cfPWV) will be at an increased risk for cardiovascular (CV) events in future. Resistin is an inflammatory mediator and a biomarker of CV diseases. We evaluated the association between serum resistin and aortic stiffness in patients with coronary artery disease (CAD). Methods A total of 104 patients with CAD were enrolled in this study. cfPWV was measured using the SphygmoCor system. Patients with cfPWV >10 m/s were defined as the high aortic stiffness group. Results Thirty-seven patients (35.6%) had high aortic stiffness and higher percentages of diabetes (p = 0.001), were of older age (p = 0.001) and had higher waist circumference (p < 0.001), systolic blood pressure (p = 0.027), pulse pressure (p = 0.013), high-sensitivity C-reactive protein (p < 0.001) and resistin levels (p < 0.001) but lower estimated glomerular filtration rate (p = 0.009) compared to subjects with low aortic stiffness. After adjusting for factors significantly associated with aortic stiffness by multivariate logistic regression analysis, serum resistin (odds ratio = 1.275, 95% confidence interval: 1.065–1.527, p = 0.008) was also found to be an independent predictor of aortic stiffness in patients with CAD. Conclusions Serum resistin level is a biomarker for aortic stiffness in patients with CAD.

Association of hyperleptinemia with peripheral arterial disease in hypertensive patients

Objective: Hypertension is a risk factor for peripheral artery disease (PAD). Serum leptin plays an important role in promoting endothelial dysfunction. The aim of this study is to investigate whether the leptin level is associated with PAD in hypertensive patients. Materials and Methods: Ninety-eight hypertensive patients were enrolled in this study. Ankle-brachial index (ABI) values were measured using an automated oscillometric device. Patients with an ABI value <0.9 were considered the low ABI group. C-reactive protein (CRP) was measured using standard enzymatic automated methods. Serum levels of human leptin were determined using a commercially available enzyme immunoassay. Results: Eighteen (18.4%) hypertensive patients were included in the low ABI group. Hypertensive patients in the low ABI group had higher serum creatinine (P < 0.001), CRP (P = 0.003), and leptin (P < 0.001) levels, higher prevalence of diabetes (P = 0.036), and current smoking (P = 0.034) than patients in the normal ABI group. Univariate linear regression analyses revealed that body weight (P = 0.014), waist circumference (P = 0.010), body mass index (P = 0.002), and logarithmically transformed CRP (log-CRP,P= 0.001) were positively correlated with serum log-leptin levels in hypertensive patients. Multivariate stepwise linear regression analysis showed that log-leptin (β = 0.439, adjusted R2 change = 0.224,P< 0.001) was also an associated factor of PAD in hypertensive patients. Conclusion: A higher log-leptin value is an independent predictor of PAD in hypertensive patients.

Inverse Association of N-terminal pro-B-type natriuretic Peptide Level with Metabolic Syndrome in Kidney Transplantation Patients

BACKGROUNDnLow levels of natriuretic peptide may activate the renin-angiotensin-aldosterone system, which may contribute to the development of obesity. Therefore, in study we aim to evaluate the relationship between metabolic syndrome (MetS) and serum N-terminal pro‒B-type natriuretic peptide (NT-proBNP) concentration in kidney transplant recipients.nnnMETHODSnFasting blood samples were obtained from 66 kidney transplant recipients. MetS and its components were defined using the diagnostic criteria of the International Diabetes Federation.nnnRESULTSnA total of 20 patients (30.3%) had MetS. Hypertension, prevalence of diabetes, use of statin or fibrate, body weight, body mass index, waist circumference, body fat mass, and levels of systolic blood pressure, total cholesterol, triglyceride, blood urea nitrogen, insulin, and HOMA-IR were higher, whereas the levels of high-density lipoprotein cholesterol and NT-proBNP were lower in patients with MetS. Logarithmically transformed creatinine and log-HOMA-IR were associated with NT-proBNP levels in a multivariable linear regression analysis. Multivariate logistic regression analysis revealed that NT-proBNP was an independent predictor of MetS in kidney transplant recipients.nnnCONCLUSIONnOur study has revealed that fasting level of NT-proBNP was negatively associated with MetS and that serum creatinine and HOMA-IR were independent predictors of serum NT-proBNP level in kidney transplant recipients.

Serum adipocyte fatty acid-binding protein level is associated with arterial stiffness quantified with cardio-ankle vascular index in kidney transplant patients

BackgroundArterial stiffness is an established marker of cardiovascular risk and an independent predictor of cardiovascular disease (CVD) events and mortality in kidney transplant (KT) patients. Adipocyte fatty acid-binding protein (A-FABP), a novel adipokine, is positively associated with atherosclerosis. The present study evaluated the relationship between fasting circulating A-FABP and peripheral arterial stiffness using the cardio-ankle vascular index (CAVI) in KT patients.MethodsFasting blood samples were collected from 74 KT patients, and serum A-FABP levels were measured using an enzyme immunoassay. CAVI was calculated using a waveform device (CAVI-VaSera VS-1000). The cutoff values for high and low levels of arterial stiffness were defined by the CAVI values of ≥9 and <9, respectively.ResultsThirty-four patients (45.9%) were classified into the high arterial stiffness group. Compared with the low arterial stiffness group, the high arterial stiffness group had higher values for age (pxa0=xa00.015), systolic blood pressure (pxa0<xa00.001), pulse pressure (pxa0<xa00.001), duration of kidney transplantation (pxa0=xa00.005), serum total cholesterol and triglyceride levels (pxa0=xa00.033 and 0.047, respectively), glomerular filtration rate (pxa0=xa00.019), fasting glucose levels (pxa0=xa00.012), and serum A-FABP levels (pxa0<xa00.001). Multivariate forward stepwise linear regression analysis showed that age (pxa0=xa00.004), systolic blood pressure (pxa0=xa00.001), and serum A-FABP levels (pxa0=xa00.003) were independent predictors of CAVI value in KT patients.ConclusionSerum fasting A-FABP level is positively associated with peripheral arterial stiffness in KT patients.

Serum cystatin C is independently associated with aortic arterial stiffness in patients with type 2 diabetes

BACKGROUNDnHigher cystatin C levels are associated with an increased cardiovascular risk. We evaluated the association between serum cystatin C and aortic arterial stiffness in patients with type 2 diabetes mellitus (DM).nnnMETHODSnFasting blood samples were collected from 170 patients with type 2 DM. Carotid-femoral pulse wave velocity (cfPWV) valuesu202f>u202f10u202fm/s were used to define the high aortic arterial stiffness group.nnnRESULTSnSixty-seven patients with DM (39.4%) were defined as the high aortic arterial stiffness group. Patients with DM in the high aortic arterial stiffness group had older age (Pu202f=u202f0.003), higher systolic blood pressure (Pu202f<u202f0.001), diastolic blood pressure (Pu202f=u202f0.045), triglyceride (Pu202f=u202f0.046), blood urea nitrogen (Pu202f=u202f0.038), creatinine (Pu202f=u202f0.006), urine albumin-to-creatinine ratio (Pu202f=u202f0.004), and serum cystatin C (Pu202f<u202f0.001) levels but lower estimated glomerular filtration rate (Pu202f<u202f0.001). Multivariate logistic regression analysis showed that serum cystatin C level (each increase of 0.1u202fmg/l, odds ratio: 1.369, 95% confidence interval (CI): 1.049-1.787, Pu202f=u202f0.021) was still an independent predictor of aortic arterial stiffness in patients with DM.nnnCONCLUSIONnSerum cystatin C level positively correlated with aortic arterial stiffness among patients with type 2 DM.

Serum leptin level positively correlates with metabolic syndrome among elderly Taiwanese

Objective: Leptin is an adipocyte-derived hormone and has shown positive correlation with obesity and metabolic syndrome (MetS) in many studies. However, there are few studies investigating this relation in elderly people. Therefore, we aimed to investigate the correlation between the fasting serum leptin level and MetS among older Taiwanese. Materials and Methods: The fasting serum leptin level was obtained from 62 Taiwanese participants over 65 years old and was measured using a commercially available enzyme immunoassay kit. MetS and its components were defined using diagnostic criteria from the International Diabetes Federation. Results: Thirty elderly participants (48.4%) had MetS. The serum leptin level was positively correlated with MetS (P < 0.001). Multivariate logistic regression analysis of the factors significantly associated with MetS showed that logarithmically transformed leptin (log-leptin, each increase 0.1 ng/mL log-leptin, odds ratio: 1.276, 95% confidence interval: 1.015–1.603,P= 0.037) was still an independent predictor of MetS in elderly persons. Univariable linear analysis showed that body weight (r = 0280,P= 0.028), body mass index (r = 0.417,P= 0.001), waist circumference (r = 0.419,P= 0.001), blood urea nitrogen (r = 0255,P= 0.046), log-insulin (r = 0436,P< 0.001), and logarithmically transformed homeostasis model assessment of insulin resistance (r = 0359,P= 0.004) positively correlated with fasting serum log-leptin levels. Multivariate forward stepwise linear regression analysis of the factors significantly associated with fasting serum log-leptin levels revealed that waist circumference (adjusted R2 = 0.083,P= 0.002), statin use (adjusted R2 = 0.058,P= 0.016), and female gender (adjusted R2 = 0.041,P= 0.034) were independent predictors of fasting serum log-leptin levels among elderly participants. Conclusion: In elderly Taiwanese, the serum leptin level was positively correlated with MetS. Waist circumference, statin use, and female gender were independent predictors of the fasting serum leptin level in elderly participants.

Elevated serum osteoprotegerin may predict peripheral arterial disease after kidney transplantation: a single-center prospective cross-sectional study in Taiwan

Background Osteoprotegerin (OPG) is a potential biomarker for severity and complications of cardiovascular diseases. Peripheral arterial disease (PAD) is associated with an increased risk of death in kidney transplantation (KT) patients. This prospective cross-sectional study evaluated the relationship between serum OPG and PAD in KT patients. Methods Seventy-four KT patients were enrolled for this PAD study. Fasting blood samples were obtained to measure serum OPG levels by using enzyme-linked immunosorbent assay kits. The ankle-brachial index (ABI) of less than 0.9 was applied for PAD diagnosis. Results Thirteen patients (17.6%) were diagnosed with PAD. Diabetes (P = 0.025), smoking (P = 0.010), and increased OPG levels (P = 0.001) were significantly more frequent in the PAD group. Multivariate logistic regression analysis showed that serum OPG (odds ratio [OR], 1.336; 95% CI [1.108–1.611]; P = 0.002) and diabetes (OR, 7.120; 95% CI [1.080–46.940]; P = 0.041) were independent predictors of PAD in KT patients. The area under the receiver operating characteristic (ROC) curve determined that the probability of a serum OPG level of 7.117 pg/L in predicting PAD in KT patients was 0.799 (95% CI [0.690–0.884]; P < 0.001). Discussion Exploration of reliable biomarkers for early identification of vascular risk is crucial for KT patients. Elevated serum OPG levels may predict PAD in KT patients with cutoff value of 7.117 pg/L.

Serum osteoprotegerin levels associated with the aortic augmentation index in renal transplant recipients

Objectives: Arterial stiffness is recognized as an independent risk factor for cardiovascular morbidity and mortality. Recent studies found that osteoprotegerin (OPG) is associated with arterial stiffness and may reflect endothelial dysfunction. The aim of this study was to evaluate the relationship between fasting serum OPG levels and the aortic augmentation index (AIx) in renal transplant recipients. Materials and methods: Fasting blood samples were obtained from 66 renal transplant recipients. The aortic AIx was measured using a validated tonometry system (SphygmoCor). Serum OPG levels were measured using a commercial enzyme-linked immunosorbent assay kit. Results: Univariate linear analysis of the aortic AIx in renal transplant recipients revealed that body fat mass (r = 0.377, p = 0.002), aortic diastolic blood pressure (DBP; r = 0.307, p = 0.020), triglycerides (r = 0.260, p = 0.035), and logarithmically transformed OPG (log-OPG, r = 0.402, p < 0.001) were positively correlated, whereas height (r = 0.361, p = 0.004) and body weight (r = 0.212, p = 0.041) were negatively correlated with the aortic AIx in renal transplant recipients. Multivariate forward stepwise linear regression analysis of the factors significantly associated with the aortic AIx showed that log-OPG (R2 = 0.213, p < 0.001), height (R2 = 0.081, p = 0.009), and aortic DBP (R2 = 0.058, p = 0.022) were independent predictors of the aortic AIx in renal transplant recipients. Conclusion: These results suggest that the serum fasting OPG level is associated with the aortic AIx in renal transplant recipients.