The relationship of circulating neuregulin 4 and irisin, and traditional and novel cardiometabolic risk factors with the risk and severity of coronary artery disease.

BACKGROUND AND AIMS: Neuregulin 4 (NRG4) and irisin are adipokines that have been suggested to be associated with cardiometabolic risk factors and coronary artery disease (CAD), but the data are inconclusive. This study aimed to investigate the relationship between circulating NRG4 and irisin and cardiometabolic risk factors with CAD risk and severity. METHODS AND RESULTS: In this cross-sectional study, the presence of CAD and the severity of stenosis (gensini score) were documented based on coronary angiography in 166 adults. Circulating NRG4 and irisin, glucose homeostasis markers, hs-CRP, lipid profiles, blood pressure, and anthropometric measurements were assessed as well. Age (p = 0.005), sex (p = 0.008), SBP (p = 0.033), DBP (p = 0.04), MAP (p = 0.018), FBG (p = 0.012), insulin (p = 0.039) and HOMA-IR (p = 0.01) were significantly associated with odds of having CAD. The final logistic regression model showed that age, sex, HOMA-IR, and MAP were the most important determinants of having CAD. There were no significant associations between circulating irisin and NRG4 with odds of having CAD. The final general linear model showed that being men (ß = 17.303, 95% CI: 7.086-27.52, P = 0.001), age (Aß = 0.712, 95% CI: 0.21-1.214, P = 0.006), HOMA-IR (Aß = 2.168, 95% CI: 0.256 to 4.079, P = 0.027), and NRG4 level (ß = 1.836, 95% CI: 0.119-3.553, P = 0.036) were directly associated with higher gensini score. Participants with the three-vessel disease had a mean increase of about 5 units in circulating irisin compared to those with no clinical CAD (ß = 5.221, 95% CI: 0.454-9.987, p = 0.032). CONCLUSIONS: This study showed that the adipokines NRG4 and Irisin might be associated with the severity of coronary stenosis.

Effect of l-arginine on cardiac reverse remodeling and quality of life in patients with heart failure.

BACKGROUND & AIMS: Heart failure (HF), as a major cardiac disease, is associated with considerable mortality, morbidities and poor quality of life. The aim of this study was to investigate the effect of l-arginine supplementation on cardiac outcomes and quality of life in patients with ischemic HF. METHODS: This double-blind randomized controlled clinical trial was conducted in 50 patients with ischemic HF. Patients were randomly assigned to receive either 3 gr/d l-arginine or placebo, for 10 weeks. Cardiac function (based on echocardiography and six-minute walk test), blood pressure, and quality of life (based on the Minnesota living with heart failure questionnaire) were assessed. RESULTS: The results showed significant improvements in ejection fraction (-6.5 ± 8.7 vs. -0.7 ± 7.8%, P = 0.037), left ventricular function (P = 0.043), diastolic dysfunction (P = 0.01) and marginally improvement in changes of left ventricular dimension during diastole (LVDd) (4 ± 6 vs. 0.3 ± 6.9 mm, P = 0.065) in the l-arginine compared to the placebo group. At the end of the study, physical aspect (5.7 ± 3.3 vs. 1.2 ± 6.1, P = 0.002) and total score (10 ± 6.7 vs. 4.1 ± 9.4, P = 0.011) of quality of life improved significantly in the l-arginine compared with the placebo group. Additionally, pre-to post-values of diastolic blood pressure, mean arterial pressure, LVDd, LV ejection fraction, left ventricular function, diastolic dysfunction as well as physical and total scores of quality of life improved significantly within the intervention, but not the placebo, group (all P < 0.05). CONCLUSION: This study showed that 3 gr/d l-arginine supplementation for 10 weeks could improve cardiac recovery and function, and quality of life in patients with HF. This study was registered at the Iranian Clinical Trial Registration Center (www.irct.ir) with IRCT20170202032367N4 code.

Role of type 2 diabetes and hemodialysis in serum adipolin concentrations: A preliminary study.

INTRODUCTION: Adipocytokines play a major role in obesity-associated disorders like insulin resistance (IR). IR is prevalent in diabetes and advanced kidney failure. Adipolin is an adipocytokine with major beneficial effects on insulin sensitivity. This study aimed to investigate adipolin concentration and its relationship with IR and other cardiovascular risk factors in patients with diabetes and/or hemodialysis. METHODS: In this preliminary study, 24 obese patients with type 2 diabetes (DM) and 30 with hemodialysis (14 with diabetes and hemodialysis (HD/DM) and 16 with hemodialysis (HD/non-DM)) were studied. Anthropometric indexes, serum concentrations of adipolin, fasting blood glucose (FBG), insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and lipid profile were assessed. FINDINGS: The results showed higher serum adipolin in DM (29 ± 35 ng/mL) than in HD/DM (13 ± 2 ng/mL, P = 0.01) and HD/Non-DM (12 ± 1.6 ng/mL, P = 0.01) groups. Insulin level was lower in DM than HD/DM (P < 0.001) and HD/Non-DM (P < 0.001) groups, and HOMA-IR was also significantly lower in DM compared to HD/DM group (P < 0.001); while, FBG was significantly higher in DM (P < 0.001) and HD/DM (P = 0.006) compared to HD/Non-DM patients. Adipolin was inversely associated with insulin level (r = -0.446, P = 0.001) and HOMA-IR (r = -0.296, P = 0.035). LDL level was higher in DM compared to HD/DM (P = 0.008) and HD/Non-DM (P = 0.005) groups. Adipolin was directly correlated with cholesterol (r = 0.348, P = 0.01) and LDL (r = 0.428, P = 0.001) concentrations. DISCUSSION: Higher adipolin level in DM group might indicate a compensatory elevation in adipolin production or secretion to modulate IR. It might also be due to medications and inflammation. Further studies are required to investigate the precise role of this adipokine in IR.