Key result
Elevated baseline leptin was not associated with overall future AVR in the discovery cohort (OR 1.10, 95% CI 0.92-1.32), and no adipokine associations remained significant after adjusting for BMI.
Why the study?
Aortic stenosis is the most prevalent adult valvular heart disease, but whether the metabolic adipokines leptin and adiponectin are independently associated with future aortic valve replacement was unknown.
Are baseline circulating levels of the adipokines leptin and adiponectin independently associated with the risk of future aortic valve replacement for aortic stenosis?
Case-Control (n=1,325)
No
Are baseline circulating levels of the adipokines leptin and adiponectin independently associated with the risk of future aortic valve replacement for aortic stenosis?
Although higher circulating leptin and lower adiponectin were associated with future aortic valve replacement for aortic stenosis in specific subgroups (such as patients with concomitant CAD or older age), none of the associations were independent of body mass index.
Answers are grounded in this paper and cite their sources.
Baseline adipokines should not inform aortic stenosis risk stratification; leaves open BMI-independent subgroup effects for prospective study.
OBJECTIVES: Aortic stenosis (AS) is the most prevalent valvular heart disease among adults. The adipocyte-derived hormones, leptin and adiponectin, have profound metabolic actions. We examined whether these adipokines are independently associated with future aortic valve replacement (AVR). DESIGN: In this longitudinal case-control study, we identified 336 cases who had undergone AVR due to AS, and who had previously participated in population-based health surveys. Two referents were matched to each case and leptin and adiponectin concentrations were analysed from stored baseline survey samples. Uni- and multivariable logistic regression analyses were used to estimate the risk of future AVR. An additional cohort was identified for validation including 106 cases with AVR and 212 matched referents. RESULTS: Median age (interquartile range (IQR)) in years at survey was 59.9 (10.4) and at surgery 68.3 (12.7), and 48% were women. An elevated concentration of leptin was not associated with future AVR (odds ratio [95% confidence interval]) (1.10 [0.92-1.32]), although leptin was associated with a higher risk in patients with coronary artery disease (CAD) having more than 5 years between survey and AVR (1.41 [1.08-1.84]). Adiponectin was not associated with higher risk for future AVR (0.95 [0.82-1.11]), although after stratification for age, higher levels were associated with reduced risk for AVR in persons aged ≥60 years at surgery (0.79 [0.64-0.98]). In the validation study, leptin was associated with future AVR whereas adiponectin was not. None of the associations remained significant after adjustment for body mass index (BMI). CONCLUSIONS: The adipokine leptin may promote the development of AS.
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Hansén et al. (2023) conducted a case-control in Aortic stenosis requiring aortic valve replacement (n=1,325). Baseline circulating leptin and adiponectin concentrations vs. Matched referents without valvular surgery (1:2 case-to-referent matching) was evaluated on Future aortic valve replacement (AVR) due to aortic stenosis (AS) associated with elevated leptin concentration in the discovery cohort (OR 1.10, 95% CI 0.92-1.32). Elevated baseline leptin was not associated with overall future AVR in the discovery cohort (OR 1.10, 95% CI 0.92-1.32), and no adipokine associations remained significant after adjusting for BMI.
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