Association of serum adipocytokine levels with cardiac autonomic neuropathy in type 2 diabetic patientsReportar como inadecuado

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Cardiovascular Diabetology

, 11:24

First Online: 13 March 2012Received: 19 December 2011Accepted: 13 March 2012


BackgroundCardiac autonomic neuropathy CAN is a common complication of diabetes associated with poor prognosis. In addition, the autonomic imbalance is associated with cardiovascular disease CVD in diabetes. It is thought that adipocytokines contribute to the increased risk of vascular complications in patients with type 2 diabetes mellitus T2DM. However, literature data on the association between CAN with adipocytokines such as leptin, tumor necrosis factor-alpha TNF-alpha, adiponectin in subjects with T2DM is limited.

Therefore, in the present study, we examined the relationship between fasting serum leptin, TNF- alpha and adiponectin and CAN in Korean T2DM patients.

MethodsA total of 142 T2DM patients 94 males, 48 females were recruited. CAN was assessed by the five tests according to the Ewing-s protocol and the time and frequency domain of the heart rate variability HRV was evaluated. Serum TNF-alpha and adiponectin levels were measured using enzyme-linked immunosorbent assay and serum leptin levels were measured using radioimmunoassay.

ResultsAlthough, the mean levels of leptin, TNF-alpha and adiponectin were not significantly different between the groups with and without CAN, the levels of leptin and adiponectin had a tendency to increase as the score of CAN increased p = 0.05, p = 0.036. Serum leptin levels demonstrated a negative correlation with low frequency LF in the upright position p = 0.037. Regarding TNF-alpha, a significant negative correlation was observed with SDNN and RMSSD in the upright position p = 0.023, p = 0.019. Adiponectin levels were not related to any HRV parameters. Multivariate logistic regression analysis demonstrated that the odds of CAN increased with a longer duration of diabetes 1.25, 1.07-1.47 and higher homeostatic model of assessment-insulin resistance HOMA-IR 5.47, 1.8-16.5. The relative risks for the presence of CAN were 14.1 and 51.6 for the adiponectin 2, 3 tertiles when compared with first tertile p-value for trend = 0.022.

ConclusionsIn the present study, the higher serum adiponectin levels and HOMA-IR were associated with an increased risk for the presence of CAN. Also, the CAN score correlated with the serum adiponectin. Serum adipocytokines such as leptin and TNF-alpha were significantly correlated with parameters of HRV, representative markers of CAN. Future prospective studies with larger number of patients are required to establish a direct relationship between plasma adipocytokine concentrations and the development or severity of CAN.

KeywordsCardiac autonomic neuropathy heart rate variability leptin TNF- alpha adiponectin type 2 diabetes mellitus AbbreviationsCANcardiac autonomic neuropathy

T2DMtype 2 diabetes mellitus

TNF- αtumor necrosis factor- α

HRVheart rate variability

LFlow frequency

HFhigh frequency

SDNNstandard deviation of normal-to-normal RR intervals

RMSSDsquare root of the mean of the squares of differences between successive RR intervals

HOMA-IRhomeostasis model assessment-insulin resistance

CVDcardiovascular disease

SNSsympathetic nervous system

AFTautonomic function test

PNSparasympathetic nervous system

PWVpulse wave velocity

ABIankle-brachial index

ACEangiotensin converting enzyme

BMIbody mass index

SBPsystolic blood pressure

FPGfasting plasma glucose


hsCRPhigh sensitivity c-reactive protein

HDL-Chigh density lipoprotein cholesterol

apoBapolipoprotein B

eGFRestimated glomerular filtration rate

OHAoral hypoglycemic agent

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Autor: Chan-Hee Jung - Bo-Yeon Kim - Chul-Hee Kim - Sung-Koo Kang - Sang-Hee Jung - Ji-Oh Mok


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