Hyperleptinaemia in chronic heart failure : Relationships with insulin

• Published in: European heart journal Vol. 19; no. 10; pp. 1547 - 1551
• Main Authors: LEYVA, F, ANKER, S. D, EGERER, K, STEVENSON, J. C, KOX, W. J, COATS, A. J. S
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-10-1998
• Subjects: Adipose Tissue - metabolism; Biological and medical sciences; Biomarkers - blood; Body Mass Index; Cardiology. Vascular system; Cardiomyopathy, Dilated - complications; Chronic Disease; Coronary Disease - complications; Heart; Heart Failure - blood; Heart Failure - etiology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Hyperinsulinism - blood; Hyperinsulinism - complications; Insulin - blood; Leptin; Male; Medical sciences; Middle Aged; Proteins - metabolism; Radioimmunoassay; Human; Heart failure; Energy metabolism; Pathophysiology; Heart disease; Leptin; Cardiovascular disease; Exploration; Insulin
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1053/euhj.1998.1045

Leptin, a product of the ob gene, is known to increase energy expenditure. Given that chronic heart failure is a hypercatabolic state, we sought to determine whether congestive heart failure involves elevations in plasma leptin levels. Since leptin secretion is up-regulated by insulin, we also explored whether in congestive heart failure, a hyperinsulinaemic state, plasma leptin levels relate to plasma insulin levels.
Male patients with weight-stable congestive heart failure (n = 25, aged 55.5 +/- 2.0, mean +/- SEM, body mass index = 27.4 +/- 0.8, radionuclide left ventricular ejection fraction = 29.3 +/- 3.0%) and 18 controls, matched for age, sex and body fat (dual energy X-ray absorptiometry), underwent measurement of fasting plasma leptin (radioimmunoassay) and insulin levels.
Compared to controls, patients with congestive heart failure had higher plasma leptin [8.12 (-1.12, +1.31) vs 4.48 (-0.61, +0.70) ng.ml-1, mean +/- asymmetrical SEM, P = 0.003], 41.5% higher plasma leptin per percent body fat mass (P < 0.001), and higher fasting insulin levels [67.8 (-11.1, +13.3) vs 32.9 (-5.7, +6.9) pmol.l-1, P = 0.010]. In the congestive heart failure group, plasma leptin correlated with total body fat (r = 0.66) and fasting insulin (r = 0.68) (both P < 0.001). In multivariate regression analyses of the congestive heart failure group, fasting insulin (standardized coefficient = 0.41, P = 0.011) emerged as a predictor of plasma leptin levels, independent of total body fat (standardized coefficient = 0.73, P = 0.002, R2 = 0.66, P < 0.001).
Plasma leptin levels are raised in patients with congestive heart failure. The observation of a positive relationship between plasma leptin and insulin concentrations suggests that the insulin-leptin axis may be related to the increased energy expenditure observed in patients with congestive heart failure.