IRISIN IN PREDICTING MAJOR ADVERSE CARDIAC EVENTS AFTER MYOCARDIAL INFARCTION IN OBESE HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS

Öz

Objective: Cardiovascular diseases (CVDs), particularly ST-elevation myocardial infarction (STEMI), remain the leading causes of mortality and disability worldwide. This study aimed to evaluate the relationship between serum irisin levels and the development of major adverse cardiovascular events (MACE) in high-risk patients with hypertension, type 2 diabetes mellitus (T2DM), and obesity following STEMI. Material and Methods: A prospective observational study included 238 hypertensive patients with T2DM and obesity (BMI>30 kg/m²) admitted with a first STEMI. Patients were divided into MACE (n=117) and non-MACE (n=121) groups. Serum irisin was measured by ELISA. MACE was assessed over 12 months and included recurrent myocardial infarction, stroke, cardiovascular death, and hospitalisation for heart failure. Results: Irisin levels were significantly lower in the MACE group (121.57±15.86 ng/mL) than in the non-MACE group (129.31±17.93 ng/ mL; p=0.0005). Patients with MACE had a significantly longer duration of hypertension and T2DM. A non-dipper blood pressure profile was more frequent in the MACE group (41.88% vs. 26.44%; p=0.0121). Multivariate logistic regression revealed that lower irisin levels (OR: 0.911; 95% CI: 0.417–0.991; p=0.041) and non-dipper BP profile were independent predictors of MACE. Conclusion: Lower irisin levels and abnormal circadian BP rhythm are associated with increased MACE risk after STEMI in patients with T2DM and obesity. Irisin may serve as a valuable biomarker for early risk stratification in such high-risk populations.

Anahtar Kelimeler

• Irisin
• myocardial infarction
• hypertension
• obesity
• dia betes mellitus

İRİSİNİN, OBEZ HİPERTANSİF TİP 2 DİYABET HASTALARINDA MİYOKARD ENFARKTÜSÜNDEN SONRA MAJÖR KARDİYAK ADVERS OLAYLARI ÖNGÖRMEDEKİ ROLÜ

Öz

Amaç: Kardiyovasküler hastalıklar (KVH), özellikle ST-yükselmeli miyokard enfarktüsü (STEMI), dünya çapında ölüm ve sakatlıkların önde gelen nedeni olmaya devam etmektedir. Bu çalışma, STEMI sonrası hipertansiyon, tip 2 diabetes mellitus (T2DM) ve obezitesi olan yüksek riskli hastalarda serum irisin seviyeleri ile majör advers kardiyovasküler olayların (MACE) gelişimi arasındaki ilişkiyi değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Prospektif gözlemsel bu çalışmaya, ilk STEMI ile başvuran T2DM ve obezitesi (VKİ>30kg/m²) olan 238 hipertansif hasta dahil edildi. Hastalar MACE (n=117) ve MACE olmayan (n=121) gruplara ayrıldı. Serum irisin düzeyleri ELISA ile ölçüldü. MACE 12 ay boyunca tekrarlayan miyokard enfarktüsü, inme, kardiyovasküler ölüm ve kalp yetmezliği nedeniyle hastaneye yatışı kapsayan bir değerlendirme yapıldı. Bulgular: İrisin düzeyleri MACE grubunda (121,57±15,86 ng/mL), MACE olmayan gruba (129,31±17,93 ng/mL; p=0,0005) kıyasla anlamlı derecede düşüktü. MACE hastalarında hipertansiyon ve T2DM süresi anlamlı derecede daha uzundu. Non-dipper kan basıncı profili MACE grubunda daha sıktı (%41,88'e karşı %26,44; p=0,0121). Çok değişkenli lojistik regresyon, düşük irisin düzeylerinin (OR: 0,911; %95 GA: 0,417-0,991; p=0,041) ve non-dipper kan basıncı profilinin MACE'nin bağımsız öngörücüleri olduğunu ortaya koydu. Sonuç: Düşük irisin düzeyleri ve anormal sirkadiyen kan basıncı ritmi, T2DM ve obezitesi olan hastalarda STEMI sonrası artmış MACE riski ile ilişkilidir. İrisin, bu tür yüksek riskli popülasyonlarda erken risk sınıflandırması için değerli bir biyobelirteç olarak görev alacağı öngörülmektedir.

Anahtar Kelimeler

• İrisin
• miyokard enfarktüsü
• hipertansiyon
• obezite
• diyabet mellitus

Kaynakça

1. Parsanathan R, Jain SK. Novel invasive and noninvasive cardiac-specific biomarkers in obesity and cardiovascular diseases. Metab Syndr Relat Disord 2020;18(1):10-30. google scholar
2. de Carvalho Ribeiro P, Oliveira LF, Filho DM, Parreira RC, Vieira MS, Marques BL, et al. Biomarkers in hypertension and hypertension-related disorders. Curr Med Chem 2023;30(34):3846-79. google scholar
3. Liu S, Cui F, Ning K, Wang Z, Fu P, Wang D, et al. Role of irisin in physiology and pathology. Front Endocrinol (Lausanne) 2022;13:962968. google scholar
4. Li H, Wang F, Yang M, Sun J, Zhao Y, Tang D. The effect of irisin as a metabolic regulator and its therapeutic potential for obesity. Int J Endocrinol 2021;2021:6572342. google scholar
5. Bao JF, She QY, Hu PP, Jia N, Li A. Irisin, a fascinating field in our times. Trends Endocrinol Metab 2022;33(9):601-13. google scholar
6. Fu J, Li F, Tang Y, Cai L, Zeng C, Yang Y, et al. The emerging role of irisin in cardiovascular diseases. J Am Heart Assoc 2021;10(20):e022453. google scholar
7. Jin L, Piao Z. Irisin protects against cardiac injury by inhibiting NLRP3 inflammasome-mediated pyroptosis during remodeling after infarction. Int Immunopharmacol 2024;130:111714. google scholar
8. Hsieh IC, Ho MY, Wen MS, Chen CC, Hsieh MJ, Lin CP, et al. Serum irisin levels are associated with adverse cardiovascular outcomes in patients with acute myocardial infarction. Int J Cardiol 2018;261:12-17. google scholar

9. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2018;39(2):119-177. google scholar
10. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28(1):1-39.e14. google scholar
11. Pusuroglu H, Cizgici AY, Demir AR, Uygur B, Ozal E. Long-term prognostic value of mean platelet volume in patients with hypertension. Acta Cardiol Sin 2021;37(5):504-11. google scholar
12. Boos CJ, Toon LT, Almahdi H. The relationship between ambulatory arterial stiffness, inflammation, blood pressure dipping and cardiovascular outcomes. BMC Cardiovasc Disord 2021;21(1):139. google scholar
13. Manea V, Leucu^a DC, Pop C, Popescu MI. The predictive risk factors Associated with non-dipper profile in patients with type 2 diabetes and hypertension. Med Pharm Rep 2024;97(3):270-79. google scholar
14. Candemir M, Kızıltunç E, Nurkoç SG, Cihan B, Şahinarslan A. Predictors of length of hospital stay and in-hospital adverse events in patients with acute decompensated heart failure: in-hospital 24-hour blood pressure monitoring data. Hellenic J Cardiol 2024;S1109-9666(24)00132-5. google scholar
15. Komori T, Hoshide S, Turana Y, Sogunuru GP, Kario K; HOPE Asia Network. Cognitive impairment in heart failure patients: association with abnormal circadian blood pressure rhythm: a review from the HOPE Asia Network. Hypertens Res 2024;47(2):261-70. google scholar
16. Chai Q, Zhang W, Gao L, Yang Y, Xin S. Serum irisin correlates to the severity of acute myocardial infarction and predicts the postoperative major adverse cardiovascular events. Biomol Biomed 2023;23(5):785-91. google scholar
17. Patoulias D, Stavropoulos K, Imprialos K, Athyros V, Grassos H, Doumas M, et al. Inflammatory markers in cardiovascular disease; lessons learned and future perspectives. Curr Vasc Pharmacol 2021;19(3):323-42. google scholar
18. Pan JA, Zhang H, Yu Q, Zhang JF, Wang CQ, Gu J, et al. Association of circulating irisin levels and the characteristics and prognosis of coronary artery disease. Am J Med Sci 2021;362(l):63-71. google scholar
19. Ozturk D, Melekoglu A, Altinbilek E, Calik M, Kosem A, Kilci H, et al. Association between serum irisin levels and ST-segment elevation myocardial infarction. Int J Gen Med 2023;16:1355-62. google scholar
20. Ho MY, Wang CY. Role of irisin in myocardial infarction, heart failure, and cardiac hypertrophy. Cells 2021;10(8):2103. google scholar
21. Bashar SM, Samir El-Sherbeiny SM, Boraie MZ. Correlation between the blood level of irisin and the severity of acute myocardial infarction in exercise-trained rats. J Basic Clin Physiol Pharmacol 2018;30(1):59-71. google scholar
22. Grzeszczuk M, Dzişgiel P, Nowinska K. The Role of FNDC5/irisin in cardiovascular disease. Cells 2024;13(3):277. google scholar
23. Hamad MS, Sarhat ER, Sarhat TR, Kasim Sakran A. Impact of serum adropin and irisin in Iraqi patients with congestive heart failure. PJMHS 2021;15(2):497-99. google scholar
24. Wang S, Hu S, Pan Y. The emerging roles of irisin in vascular calcification. Front Endocrinol (Lausanne) 2024;15:1337995. google scholar
25. Ou-Yang WL, Guo B, Xu F, Lin X, Li FX, Shan SK, et al. The controversial role of irisin in clinical management of coronary heart disease. Front Endocrinol (Lausanne) 2021;12:678309. google scholar
26. Li J, Xie S, Guo L, Jiang J, Chen H. Irisin: linking metabolism with heart failure. Am J Transl Res 2020;12(10):6003-14. google scholar
27. Almeida Gonzalez D, Rodrıguez-Perez MDC, Fuentes Ferrer M, Cuevas Fernândez FJ, Marcelino Rodrıguez I, Cabrera de Leon A. İrisin, in women and men: blood pressure, heart rate, obesity and insulin resistance. Front Endocrinol (Lausanne) 2023;14:1193110. google scholar