Relationship key factor of inflammation and the development of complications in the late period of myocardial infarction in patients with visceral obesity

Gruzdeva et al. BMC Cardiovascular Disorders (2017) 17:36 DOI 10.1186/s12872-017-0473-x RESEARCH ARTICLE Open Access Relationship key factor of inflammation and the development of complications in the late period of myocardial infarction in patients with visceral obesity Olga Gruzdeva1, Evgenya Uchasova1* , Yulia Dyleva1, Olga Akbasheva2, Vera Matveeva1, Victoria Karetnikova1, Alexander Kokov1 and Olga Barbarash1 Abstract Background: Cytokines play an significant role in regulating non-specific inflammatory response involved in many pathological processes. The current study tested the hypothesis that myocardial infarction in patients with obesity can lead to increased production of proinflammatory cytokines and unfavorable course of the pathological process. Methods: The study recruited 232 male patients with ST-elevated myocardial infarction. The mean age of the patients was 58.7 (52.2-69.9) years. All the patients were assigned to two groups according to the computed tomography findings: 1 (n = 160) patients with visceral obesity (VO), and 2 (n = 72) patients without VO. Interleukins were measured in blood serum on days 1 and 12 after MI. Results: All patients with MI demonstrated elevated levels of proinflammatory markers and reduced anti-inflammatory markers in the in-hospital period. The results suggested that among all studied inflammatory markers IL-6 (OR 1.9; 95% CI (1.6–2.8) and CRP (OR 1.3; 95% CI (1.1–1.8) were closely related to VO. One year after MI adverse cardiovascular outcome frequently occurred in patients with VO. There were two cardiac deaths (3.1%), 6 cases (9.3%) of recurrent MI, 19 cases (29.6%) of repeated hospitalizations for unstable angina, whereas only 2 patients without VO (6.6%) were hospitalized for unstable angina. The results of the logistic regression analysis demonstrated that IL-6, IL-12, and IL-10 had the highest predictive value for occurrence of adverse cardiovascular events in patients with VO. Conclusion: Cytokine profile in MI patients with VO is characterized by an imbalance caused by elevated pro-inflammatory interleukins and decreased anti-inflammatory interleukins. Obesity in patients was associated with a marked increase in IL-6 and CRP levels. Background Cytokines play an significant role in regulating non-specific inflammatory response involved in many pathological processes [1]. Pro-inflammatory (TNF-α, IL-1β, IL-6, IL-8 and IL-12) and anti-inflammatory (IL-10) cytokines defines adaptive course of inflammation. An imbalance in the can lead to chronic inflammation. Chronic inflammation is a key factor in the initiation and progression of * Correspondence: 1 Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Disease”, Kemerovo, Russia Full list of author information is available at the end of the article atherosclerosis that ultimately results in the destabilization of atherosclerotic plaques, coronary artery thrombosis, myocardial infarction (MI) [1]. Obesity-induced adipose tissue inflammation is considered to be an independent risk factor for cardiovascular disease (CVD), which is the leading cause of death and disability among working-age people in developed countries [2]. Cytokines are produced mainly by immune system cells and adipocytes [3]. The expression of the anti-inflammatory cytokines is stimulated in adipose tissue of healthy subjects, while large quantities of pro-inflammatory cytokine are secreted in patients with CVD [4]. The current study tested the © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Gruzdeva et al. BMC Cardiovascular Disorders (2017) 17:36 hypothesis that myocardial infarction in patients with obesity can lead to increased production of proinflammatory cytokines and unfavorable course of the pathological process. Purpose To study the relationships between key inflammatory factors and complications in the late post myocardial infarction period in patients with visceral obesity. Methods The study recruited 232 male patients with MI. Acute MI was diagnosed according to the 2007 Russian National Cardiology Society guidelines and ESC/ACCF/ AHA/WHF based on clinical (presence of typical pain lasting longer than 15 min), electrocardiographic (STsegment elevation of 0.1 mW in two or more contiguous leads), echocardiographic and biochemical signs (elevated creatine phosphokinase, creatine phosphokinaseMB, troponin T levels(>0,1 ng/ml). The exclusion criteria were as follows: age <50 or >80 years, the presence of T2DM, and a prior history of pronounced renal failure (glomerular filtration rate <30 mL/min). Also excluded from the study were excluded HIV-infected patients, and cancer patients with known pathology [5]. All patients provided written informed consent prior to their participation in the study. The mean age of the patients was 58.7 (52.2–69.9) years. All the patients underwent multi-slice computed tomography (CT) using a Lightspeed VCT 64 (General Electric, Fairfield, CT, USA) to measure abdominal adipose tissue. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas as well as the ratio of VAT to SAT were measured. Two diagnostic criteria (the proposed method L. Sjoestrom) were used to confirm visceral obesity (VO): VAT area >130 cm2 and the ratio of VAT to SAT ≥0.4 [6]. All the patients were assigned to two groups according to the CT findings: Group 1 (n = 160) patients with VO, and Group 2 (n = 72) patients without VO. The clinical and demographic data are shown in Table 1. All the patients underwent primary percutaneous coronary intervention of the infarct-related artery as a reperfusion therapy. The control group included 30 males without diagnosed CVD and comparable in age and sex with the patients included in the study (aged 58.42 (52.2– 61.1) years). The CT findings demonstrated that none of the control subjects suffered from VO (VAT area was 110.0 [104.0–128.0] cm2 and the VAT/SAT ratio 0.35 [0.2–0.39]). Page 2 of 8 Blood sampling and biochemical assays The serum of each patient was separated from blood by centrifugation at 3 000 × g for 20 min and stored at −70 °C. Proinflammatory markers were measured in blood serum on days 1 and 12 after MI. Serum concentrations of interleukins (IL-1β, IL-6, IL-8, IL-10 IL-12 and TNF-α,) were determined with ELISA using the Monobind ELISA test systems (USA). C-reactive protein (CRP) levels were measured using a standa (...truncated)