Humoral mediators in men with acute coronary syndrome and hypertension

Objective. Cross-sectional study of lipid metabolism regulation and coronary angiographic data parameters in men admitted to the hospital due to acute coronary syndrome (ACS).

Design and methods. The presence of hypertension (HTN) combined with several related biological risk factors of chronic non-infectious diseases were assessed. We included 98 men with ACS (73 patients with myocardial infarction and 25 subjects with unstable angina). All patients underwent an urgent coronary angiography. We assessed the presence of risk factors of chronic non-infectious diseases (CNID), such as HTN, abdominal obesity, dyslipidemia and hyperglycemia. Plasma levels of leptin and adiponectin were evaluated.

Results. HTN was diagnosed in 81 % men with ACS. Among patients with three or more CNID risk factors, HTN is found in 100 %. The highest leptin level (12 [7,3-19,0] ng/ml) was found in patients with both HTN and abdominal obesity, compared to those with isolated HTN (2,2 [0,7-4,3] ng/ml; p = 0,0) or abdominal obesity (7,3 [7,1-8,4] ng/ml; p = 0,022). In patients with both HTN and dyslipidemia, adiponectin level is lower (21,5 [10,6-35,3] μg/ml) than in those with HTN alone (40,5 [12,8-71,6] μg/ml; p = 0,026). Also, in patients with combination of HTN and dyslipidemia, the coronary artery stenosis is significantly more pronounced (99,5 [90-100] %) than in those with HTN alone (70 [45-95] %; p = 0,004). In subjects with all three risk factors leptin levels (18,1 [9,5-26,4] ng/ml), the ratio leptin/adiponectin (0,7 [0,2-1,2] U) and the level of coronary artery stenosis (100 [86,2-100] %) are higher than in individuals with < 3 risk factors (4,2 [1,1-8,4] ng/ml; p = 0,0; 0,2 [0,03-0,5] U; p = 0,001 and 90 [60-100] %, respectively). Subjects with three or more risk factors of CNID show more frequently increased leptin level (n = 34; 81 %) (odds ratio (OR) = 6,4 95 % confidence interval (95 % CI) [2,3; 17,3]) and acute coronary artery stenosis (n = 40; 83 %) (OR = 2,7 CI 95 % [1,0; 7,2]). In contrast, those with less than three CNID risk factors have lower rate of increased leptin and coronary stenosis (n = 16; 40 %; p < 0,01 and n = 28; 65 %; p = 0,046, respectively).

Results. In our study, HTN appeared to be the most common biological risk factor in men with ACS. Thus, when more than 3 risk factors are present, HTN seems to be an essential one. In addition, the presence of three or more biological risk factors is associated with increased leptin levels and acute coronary artery stenosis.

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