The Association Between Serum Leptin Levels and Cardiovascular Events in Patients With Rheumatoid Arthritis

Jiliang Chen, MD; Zhiping Xie, PhD; Zou Bin, MD

Disclosures

Lab Med. 2021;52(1):86-92. 

In This Article

Discussion

The new findings in this study: (i) serum leptin levels were independently and significantly related with CVD history in patients with RA at baseline, and (ii) higher leptin levels in patients with RA at baseline were directly associated with an increased risk of CV events during a 3-year follow-up.

A high rate of CV complications in patients with RA leads to poor prognosis.[3,4] Therefore, it is significant for clinicians to find risk factors of CV events and use them as targets for therapy or predictions for prognosis. Leptin, a hormone secreted from adipocytes, is involved in the regulation of energy expenditure and appetite.[10,11] Many studies have indicated that leptin participates in the regulation of immunity and inflammation responses. It can induce the secretion of tumor necrosis factor-a, interleukin-6, interleukin-1, and other proinflammatory cytokines in vivo and in vitro, which promotes systemic inflammation in the body.[12–16] Several clinical studies have also shown that leptin is significantly correlated with CVDs including coronary heart disease and stroke.[21–23] In addition, there is an association between leptin and oxidative stress: leptin has a facilitating role in oxidative stress, which causes the activation of inflammation in many organs or tissues.[24,25] Disproportionately increasing inflammation and oxidative stress play an important role in the occurrence and development of CV events in patients with RA.[3,4] In view of the potential regulatory role of leptin in inflammation and oxidative stress in CVD, our findings underscore that leptin is involved in the occurrence and development of CV events in patients with RA. Our results also showed that patients with RA with higher serum leptin levels had a higher rate of CV mortality during the follow-up period, consistent with the results of previous studies on the association of leptin with CVDs.[12–16,21–25] However, different from earlier research, our work included a composite endpoint, including myocardial infarction, stroke, peripheral vascular disease, and CV death, in patients with RA in a follow-up cohort study.

This study has some notable strengths. First, we found that serum leptin levels may be used as an effective prognostic factor for CV events in patients with RA, and the serum test is simple and convenient for patients in general. Second, we ensured comprehensive follow-up and rigorous adjudication of CV events, with more reliable data than have been generated in the literature. Sufficient confounding factors were corrected for the association between serum leptin levels and CV events.

The limitation of the study is that it is a single-center study with a small sample size. It is necessary for more multicenter and large-sample studies to be implemented to identify the association between serum leptin levels and CV outcomes in patients with RA in the future.

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