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Mediation effect of antithrombin III between chronic renal insufficiency and chronic coronary artery disease in T2DM patients

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Abstract

Purpose

The study aimed to investigate the potential effect of Antithrombin III (ATIII) between chronic renal insufficiency and chronic coronary artery disease (chronic CAD) in type 2 diabetes mellitus (T2DM) patients.

Methods

T2DM patients hospitalized in ZhongDa Hospital from 2013 to 2018 were enrolled. Relationships between renal function, ATIII, and chronic CAD risk were explored using multivariate regression models. Multiplicative and additive interactions were investigated between ATIII and renal function for CAD risk, and the role of ATIII was determined by bootstrap mediation analysis in patients with chronic renal dysfunction.

Results

A total of 4197 patients were included in the study, with a chronic CAD prevalence of 23.02%. Low ATIII level was statistically associated with chronic renal insufficiency and elevated CAD risk even after adjustments (P < 0.05). A positive correlation between renal function and ATIII was demonstrated, and each 1 SD increase in renal function, ATIII increased by 2.947% (2.406–3.488%, P < 0.001) and 0.969% (0.297–1.642%, P < 0.001) in crude and adjusted models respectively. Patients with decreased renal function and ATIII were at the highest chronic CAD risk (OR = 1.51, 95%CI:1.15–1.98, P < 0.05), while no multiplicative and additive interaction effects were significant. Bootstrap mediation analysis estimated that ATIII mediated approximately 4.27% of the effect of chronic renal insufficiency on chronic CAD risk.

Conclusion

ATIII may serve as a mediator between chronic renal insufficiency and chronic CAD, providing mechanistic clues for renal-heart association and new insight into clinical therapies.

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Funding

This work was supported by the National Natural Science Foundation of China (No. 81870568, Shaohua Wang).

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  1. These authors contributed equally: Ruoyu Sun, Jianhong Jia

Authors and Affiliations

  1. Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China

    Ruoyu Sun, Shaohua Wang, Chenchen Wang & Yang Yuan

  2. School of Medicine, Southeast University, Nanjing, 210009, China

    Ruoyu Sun & Yang Yuan

  3. Department of Endocrinology, Siyang Hospital of Traditional Chinese Medicine, Suqian, 223700, China

    Jianhong Jia

  4. Gansu Province Maternal and Child-Care Hospital, Lanzhou, 730050, China

    Zheng Wang

  5. College of Computer Science and Technology, Zhejiang University, Hangzhou, 310058, China

    Yanchao Xu

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by R.S. and Z.W. The first draft of the manuscript was written by R.S. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Sun, R., Jia, J., Wang, S. et al. Mediation effect of antithrombin III between chronic renal insufficiency and chronic coronary artery disease in T2DM patients. Endocrine (2024). https://doi.org/10.1007/s12020-023-03669-0

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