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Schiborn C, Weber D, Grune T, Biemann R, Jäger S, Neu N, Müller von Blumencron M, Fritsche A, Weikert C, Schulze MB, Wittenbecher C. Retinol and Retinol Binding Protein 4 Levels and Cardiometabolic Disease Risk. Circ Res 2022; 131:637-649. [PMID: 36017698 PMCID: PMC9473720 DOI: 10.1161/circresaha.122.321295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Despite mechanistic studies linking retinol and RBP4 (retinol binding protein 4) to the pathogenesis of cardiovascular diseases (CVD) and type 2 diabetes (T2D), epidemiological evidence is still conflicting. We investigated whether conflicting results of previous studies may be explained by differences in the association of retinol and RBP4 with cardiometabolic risk across subgroups with distinct sex, hypertension state, liver, or kidney function. METHODS We used case-cohorts nested in the EPIC (European Prospective Investigation Into Cancer and Nutrition)-Potsdam cohort (N=27 548) comprising a random sample of participants (n=2500) and all physician-verified cases of incident CVD (n=508, median follow-up time 8.2 years) and T2D (n=820, median follow-up time 6.3 years). We estimated nonlinear and linear multivariable-adjusted associations between the biomarkers and cardiometabolic diseases by restricted cubic splines and Cox regression, respectively, testing potential interactions with hypertension, liver, and kidney function. Additionally, we performed 2-sample Mendelian Randomization analyses in publicly available data. RESULTS The association of retinol with cardiometabolic risk was modified by hypertension state (P interaction CVD<0.001; P interaction T2D<0.001). Retinol was associated with lower cardiometabolic risk in participants with treated hypertension (hazard ratioper SD [95% CI]: CVD, 0.71 [0.56-0.90]; T2D, 0.81 [0.70-0.94]) but with higher cardiometabolic risk in normotensive participants (CVD, 1.32 [1.06-1.64]; T2D, 1.15 [0.98-1.36]). Our analyses also indicated a significant interaction between RBP4 and hypertension on CVD risk (P interaction=0.04). Regarding T2D risk, we observed a u-shaped association with RBP4 in women (P nonlinearity=0.01, P effect=0.02) and no statistically significant association in men. The biomarkers' interactions with liver or kidney function were not statistically significant. Hypertension state-specific associations for retinol concentrations with cardiovascular mortality risk were replicated in National Health and Nutrition Examination Survey III. CONCLUSIONS Our findings suggest a hypertension-dependent relationship between plasma retinol and cardiometabolic risk and complex interactions of RBP4 with sex and hypertension on cardiometabolic risk.
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Affiliation(s)
- Catarina Schiborn
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (C.S., D.W., T.G., S.J., N.N., M.M.v.B., M.B.S., C. Wittenbecher).,German Center for Diabetes Research (DZD), Neuherberg, Germany (C.S., S.J., A.F., M.B.S., C. Wittenbecher)
| | - Daniela Weber
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (C.S., D.W., T.G., S.J., N.N., M.M.v.B., M.B.S., C. Wittenbecher)
| | - Tilman Grune
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (C.S., D.W., T.G., S.J., N.N., M.M.v.B., M.B.S., C. Wittenbecher).,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany (T.G.)
| | - Ronald Biemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Germany (R.B.)
| | - Susanne Jäger
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (C.S., D.W., T.G., S.J., N.N., M.M.v.B., M.B.S., C. Wittenbecher).,German Center for Diabetes Research (DZD), Neuherberg, Germany (C.S., S.J., A.F., M.B.S., C. Wittenbecher)
| | - Natascha Neu
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (C.S., D.W., T.G., S.J., N.N., M.M.v.B., M.B.S., C. Wittenbecher)
| | - Marie Müller von Blumencron
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (C.S., D.W., T.G., S.J., N.N., M.M.v.B., M.B.S., C. Wittenbecher)
| | - Andreas Fritsche
- German Center for Diabetes Research (DZD), Neuherberg, Germany (C.S., S.J., A.F., M.B.S., C. Wittenbecher).,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Germany (A.F.).,Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine, University of Tübingen, Germany (A.F.)
| | - Cornelia Weikert
- Department of Food Safety, German Federal Institute for Risk Assessment, Berlin, Germany (C. Weikert)
| | - Matthias B. Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (C.S., D.W., T.G., S.J., N.N., M.M.v.B., M.B.S., C. Wittenbecher).,German Center for Diabetes Research (DZD), Neuherberg, Germany (C.S., S.J., A.F., M.B.S., C. Wittenbecher).,Department of Food Safety, German Federal Institute for Risk Assessment, Berlin, Germany (C. Weikert)
| | - Clemens Wittenbecher
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (C.S., D.W., T.G., S.J., N.N., M.M.v.B., M.B.S., C. Wittenbecher).,German Center for Diabetes Research (DZD), Neuherberg, Germany (C.S., S.J., A.F., M.B.S., C. Wittenbecher).,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (C. Wittenbecher).,Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden (C. Wittenbecher)
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