Author + information
- Seth S. Martin,
- Michael Blaha,
- Evan Muse,
- Atif Qasim,
- Muredach Reilly,
- Roger Blumenthal,
- Khurram Nasir,
- Michael Criqui,
- Robyn McClelland,
- Tamara B. Harris,
- Jan Hughes-Austin and
- Matthew Allison
Obesity and heart failure (HF) are growing public health concerns. Leptin is a pleiotropic adipocyte-derived hormone and cytokine that is potentially implicated in HF via multiple pathways including hypertensive effects and direct effects on the myocardium. Circulating leptin levels vary substantially by gender, however few women were included in prior studies of leptin and HF outcomes.
This ancillary MESA study included 1,916 multi-ethnic men and women without prior cardiovascular disease, aged 45 to 84 years, with data on leptin (Linco, St. Charles, MO) and incident HF. We performed multivariable Cox regression of incident HF in relation to log-transformed leptin levels in the overall cohort and by gender strata. The proportional hazards assumption was verified in all models.
Participants were aged 64.7±9.7 years (mean±SD) and equally distributed by gender (960 women, 963 men). After a median follow-up of 4.6 years, 38 HF events occurred (18 in women, 20 in men). Leptin levels were significantly higher (p<0.001) in women (median, 25.1 ng/ml; IQR, 12.8 to 42.3 ng/ml) versus men (median, 7.1; IQR, 3.3 to 14.3). Adjusting for age, gender, and ethnicity in the overall cohort, leptin levels were not significantly associated with HF (hazard ratio for 1 SD increase in ln(leptin), 1.21; 95% Cl, 0.85 to 1.73, p=0.29). Stratifying by gender, though no association was observed in men (hazard ratio for 1 SD increase in ln(leptin) adjusted for age and ethnicity, 0.97; 95% Cl, 0.62 to 1.51, p=0.90), there was an association of borderline statistical significance between leptin levels and HF in women (hazard ratio, 1.88; 95% Cl, 0.99 to 3.55, p=0.052). This association in women was lost after further adjustment for body mass index (hazard ratio, 1.19; 95% Cl, 0.54 to 2.63, p=0.68).
In this gender balanced, population based cohort of asymptomatic, middle-aged to elderly, and multi-ethnic individuals, a signal in women but not men for greater risk of incident HF in association with higher leptin levels was abrogated by adjustment for body mass index. Gender modification in pathways between obesity, leptin and HF warrants exploration in additional prospective cohort studies.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Epidemiology, Risk Modeling and Prediction of Outcomes in Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1308-299
- 2013 American College of Cardiology Foundation