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Hemostasis and fibrinolysis in non-diabetic overweight and obese men and women. Is there still a role for leptin?

¹ Department of Diabetology, Metabolism and Clinical Nutrition and ² Laboratory of Hematology and Hemostasis, Faculty of Medicine, Antwerp University Hospital, University of Antwerp (UA), Antwerp, Belgium and ³ Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, USA

(Correspondence should be addressed to L F Van Gaal; Email: luc.van.gaal{at}uza.be)

Objective: Leptin has been associated with disturbances in hemostasis and fibrinolysis, with inconsistent results on the influence of fat mass. However, the influence of the amount of visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) has not yet been studied. In this study, we investigated the relationship between leptin and fibrinogen, von Willebrand factor antigen (vWF:Ag), and plasminogen-activator inhibitor-1 (PAI-1) activity and determined the influence of associated metabolic variables and VAT versus SAT.

Methods: Fibrinogen, vWF:Ag, PAI-1,VAT and SAT (CT-scan), and insulin resistance (homeostasis model assessment; HOMA-IR) were measured in 199 women and 81 men with overweight or obesity visiting the weight management clinic of a university hospital.

Results: Leptin did not relate to fibrinogen (r = 0.11 and 0.13 in women and men respectively; P > 0.05), a relationship with vWF:Ag was only found in men (r = 0.31; P = 0.005), while leptin related to PAI-1 activity in both men (r = 0.36; P < 0.001) and women (r = 0.23; P < 0.001). Further analysis showed leptin to have an effect on the variation of PAI-1 independent of VAT and HOMA-IR in women, but not in men. Multiple regression showed HOMA-IR to be the most important determinant of PAI-1, both in men and women, but leptin also showed an independent effect. As for vWF:Ag, leptin was an independent determinant in men only.

Conclusions: PAI-1 related to leptin levels independent of fat mass percentage, HOMA-IR, and the amount of VAT and SAT. For vWF:Ag this relationship was found only in men, and not in women, while a relationship with fibrinogen could not be demonstrated.

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