Background: Recently, the adipocyte derived proteins; adiponectin and leptin, have
been found to be associated with obesity, type 2 diabetes, insulin resistance,
hyperinsulinemia, dyslipidemia and the presence of coronary artery disease.
However, the association of these proteins with the degree of coronary
atherosclerosis has not been not been well elucidated. Objectives: To determine the
relationship between serum adiponectin and leptin levels and the presence and
degree of coronary atherosclerosis. Methods: Seventy patients performing diagnostic
coronary angiography in our catheterization laboratory for the investigation of
coronary artery disease (CAD) were recruited. The control group included (20
subjects) who were non-diabetics, non-hypertensives, with no history of previous
acute coronary syndrome, having normal ECG, of matched age, sex, body mass index
(BMI), and waist/hip ratio, performing coronary angiography for stable angina with
inadequate exercise test results, and proved to have a completely normal coronary
angiography. All cases and control were subjected to complete history and clinical
examination including 12 lead ECG, measurement of BMI, and hip/waist ratio.
Fasting blood glucose, full lipogram, serum adiponectin, and serum leptin were
measured. Angiographic evaluation of coronary atherosclerosis was performed by
assessing three atherosclerotic indices; severity (transverse disease), extent
(longitudinal disease), and pattern (lesion complexity). Results: The independent
predictors of the atherosclerosis lesion severity were larger waist/hip ratio (beta,
0.34), followed by higher LDL-cholesterol (beta, 0.32), low serum adiponectin level
(beta, -0.23), older age (beta, 0.19), higher leptin level (beta, 0.17), current unstable
angina (beta, 0.17), and finally previous myocardial infarction (MI) (beta, 0.14). This
model is a good one as indicated from the model adjusted r2 (50%). For the extent of
atherosclerosis index lower serum adiponectin level was by far the most important
independent predictor (beta, -0.45), followed by higher LDL-cholesterol (beta, 0.23),
older age and previous MI (beta, 0.21 for both), while higher serum leptin level was
only a univariate predictor. The model adjusted r2 was 65%. For the atherosclerosis
pattern index, the independent predictors were previous MI (beta, 0.31), lower serum
adiponectin level (beta, -0.29), larger waist/hip ratio (beta, 0.26), higher serum leptin
level (beta, 0.24), older age (beta, 0.22), and higher fasting blood glucose level (beta,
20). The model adjusted r2 was 62%. Conclusion: Both serum adiponectin and leptin  might play an important pathogenic role not only in the occurrence but also in the severity, extent and lesion complexity in CAD patients.