The Role of Adiponectin and Leptin in Fibro-Calcific Aortic Valve Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Fibro-calcific aortic valve disease (FCAVD) is a progressive disorder characterized by the thickening and calcification of the aortic valve, eventually leading to aortic stenosis. Adiponectin and leptin, known for their anti-inflammatory and proinflammatory properties, respectively, have been implicated in cardiovascular diseases, but their associations with FCAVD are controversial. This meta-analysis aims to evaluate the relationships between adiponectin and leptin levels and FCAVD, particularly in patients with severe aortic stenosis (AS).

Methods: A systematic search was conducted across the PubMed, Scopus, and Web of Science databases to identify studies on adiponectin and leptin levels in FCAVD. The methodological quality of each study was assessed using the Newcastle-Ottawa Scale. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated, and publication bias was evaluated using Egger's test and funnel plots.

Results: Out of 191 articles identified, 10 studies involving 2360 patients (989 with FCAVD and 1371 controls) were included. The analysis suggested trends in the associations of lower adiponectin levels (SMD = -0.143, 95% CI: -0.344, 0.057, p = 0.161) and higher leptin levels (SMD = 0.175, 95% CI: -0.045, 0.395, p = 0.119) with FCAVD. The association remained a trend for low adiponectin but showed a significant correlation with high leptin in severe AS patients (SMD = 0.29, 95% CI: 0.036, 0.543, p = 0.025).

Conclusion: This meta-analysis indicates a potential association between elevated leptin levels and severe aortic stenosis, while the relationship with adiponectin levels remains inconclusive. These findings highlight the need for further and dedicated research to clarify the roles of these adipokines in the pathogenesis of FCAVD and their potential roles as biomarkers for disease progression.

Keywords: adipokines; adiponectin; aortic stenosis; fibro-calcific aortic valve disease; leptin.

Figure 1

Prisma Flow Chart. The flow chart represents the number of studies evaluated according to PRISMA guidelines.

Figure 2

Forest plots of the adipokine levels’ associations with fibro-calcific aortic valve disease. Adiponectin [14,31,32,33,34] (A) and leptin [14,22,29,30,31,34,35,36] (B) levels in patients with fibro-calcific aortic valve disease were presented as standardized differences in means (SMDs) compared to controls. The blue diamonds represent the estimated overall effect, while the squares represent each study with 95% CIs.

Figure 3

Forest plots of the adipokine levels’ associations with severe aortic valve stenosis. Adiponectin [14,31,33,34] (A) and leptin [14,22,29,31,35] (B) levels in patients with aortic stenosis were presented as standardized differences in means (SMDs) compared to controls. The blue diamonds represent the estimated overall effect, while the squares represent each study with 95% CIs.