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GLP-1 Serum Levels Associated with Coronary Artherosclerosis

Prior reports of GLP-1 vasoprotective effects may not be valid….

Prior reports have shown that GLP-1 concentrations are associated with anti-inflammatory and atheroprotective effects which extend to cardioprotection during acute myocardial infarction. In the body, GLP-1 binds to its receptors on pancreatic beta-cells leading to glucose dependent insulin release. Studies have shown conflicting results to the levels of endogenous GLP-1 concentrations in obesity and insulin resistance. Also, the relevance of endogenous GLP-1 serum levels for cardiovascular risk prediction in humans has so far not been considered. In this study, researchers aimed to assess the associations between GLP-1 serum levels and coronary atherosclerosis in humans.

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Researchers collected blood samples from 303 consecutive patients who underwent DSCT-coronary angiography for exclusion of coronary artery stenosis due to stable typical or atypical chest pain. A plaque score was calculated based on the number of diseased segments. Adequate image quality for evaluation of coronary plaques was obtained in 281 of 303 patients.

In the results, the mean amount of coronary plaque burden detected by CT angiography was 3 (range 0 to 26). Coronary plaques were not detectable in 60 patients. The median GLP-1 in random non-fasting serum samples was 2.9 pM (IQR: 1.5–4.9). GLP-1 was found to positively correlate with serum triglycerides while a weak negative correlation was found with kidney function as defined by eGFR (estimate glomerular filtration rate). Additional regression analysis found a statistically significant relationship between GLP-1 and a near-significant relationship between GLP1 and eGFR. The multiple logistic regression model revealed that GLP-1 was significantly associated with total coronary plaque burden in a model adjusted for age, sex, BMI, hypertension, diabetes, smoking, LDL, CRP, eGFR and triglycerides.

This study confirms a positive association between GLP-1 serum levels and serum triglycerides. The positive association between GLP-1 serum levels and coronary artery disease found in this study was surprising considering prior reports of the vasoprotective efficacy of GLP-1 and its analogues in experimental models. The study was limited by its underrepresentation of diabetic patients (7% of the population). The authors conclude that additional investigations in larger cohorts are needed to further explore the association between GLP-1 and cardiovascular disease in larger cohorts under consideration of clinical outcome data.

Practice Pearls:

  • Studies have shown conflicting results to the levels of endogenous GLP-1 concentrations in obesity and insulin resistance.
  • GLP-1 was found to positively correlate with serum triglycerides while a weak negative correlation was found with kidney function as defined by eGFR (estimate glomerular filtration rate)
  • The multiple logistic regression model revealed that GLP-1 was significantly associated with total coronary plaque burden in a model adjusted for age, sex, BMI, hypertension, diabetes, smoking, LDL, CRP, eGFR and triglycerides.

Cardiovascular Diabetology, August 20136