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The role of leptin in cardiovascular outcomes in patients with type 2 diabetes: an analysis of he bypass angioplsty revascularization investigation 2 diabetes (BARI 2D) trial data

Bizhanova, Zhadyra (2018) The role of leptin in cardiovascular outcomes in patients with type 2 diabetes: an analysis of he bypass angioplsty revascularization investigation 2 diabetes (BARI 2D) trial data. Master Essay, University of Pittsburgh.

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Background: Previous studies have reported that leptin increases the risk of atherogenesis and cardiovascular (CV) disease. However, the role that leptin plays in the development of atherosclerosis and the risk of CV events is complex in patients with type 2 diabetes.
Objective: Evaluate the association between altered baseline leptin profiles and baseline atherosclerosis measurements in Bypass Angioplasty Revascularization Investigation Type 2 Diabetes (BARI 2D) patients with type 2 diabetes mellitus (T2DM) and determine if the association between baseline leptin and subsequent CV events was modified by the severity of baseline atherosclerosis.
Methods: BARI 2D was a clinical trial with 2x2 factorial design that simultaneously randomized 2,368 participants with T2DM to prompt or delayed revascularization and to insulin sensitizing or insulin providing treatment. Atherosclerosis at baseline was quantified with the Myocardial Jeopardy Index (MJI). The cross-sectional associations between baseline leptin and MJI accounting for other demographic and clinical characteristics were tested using chi-square tests, Wilcoxon tests, and linear regression models. The effect of baseline leptin on subsequent CV events was assessed using Kaplan-Meier estimates, log rank tests and Cox proportional hazard regression models.
Results: Patients with lower leptin levels had significantly higher baseline BMI, insulin and C-reactive protein levels. In multivariate linear regression models with the adjustment for demographics and clinical risk factors of CVD, each SD increase baseline leptin levels were significantly associated with the estimated 1.92% increase in MJI scores (β(se): 1.92 (0.67), p-value=0.004); however, upon inclusion of BMI, the association was attenuated β(se): 0.31 (0.77), p-value=0.69). Unadjusted Kaplan-Meier survival analyses indicated that the risk of MI was greatest for patients with low leptin levels (mortality rate=14%, p-value=0.06). The association between baseline and subsequent CV outcomes was not modified by severity of baseline atherosclerosis (MJI).
Conclusion: Low leptin could serve as a clinical predictor of future MI among participants with T2DM, which may potentially lead to an intervention. This has public health significance when considering the large disease and economic burden of both T2DM and CVD morbidities in the United States.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Bizhanova, Zhadyrazhb10@pitt.eduzhb
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairBrooks, MariaMBROOKS@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberBertolet, Marniebertoletm@edc.pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberMulukutla, Sureshmulukutlasr@upmc.eduUNSPECIFIEDUNSPECIFIED
Centers: Other Centers, Institutes, Offices, or Units > Epidemiology Data Center
Date: 25 April 2018
Date Type: Submission
Number of Pages: 58
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: leptin, obesity, diabetes mellitus, cardiovascular disease
Date Deposited: 14 Nov 2018 16:51
Last Modified: 01 May 2023 05:15


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