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Abstract

Background Atherosclerosis is an inflammatory disease of the large arteries, a buildup of fatty plaque inside the arteries, leading to narrowing and hardening of the blood vessels. Objective: Find the relation of leptin and insulin resistance in clinical-subclinical coronary atherosclerosis and its relationship with diabetes mellitus. Material and Method: The cross-sectional study includes 90 males with a mean age of 33.00±6.131. They were used in the present study and divided into 45 patients with clinical coronary atherosclerosis, with a mean age of 34.500±4.949, and 45 patients with subclinical coronary atherosclerosis, with a mean age of 32.250±7.228, with ages ranging from 20 to 60 years. Serum concentrations of leptin (LEP), insulin (INS), and C-peptide (C-P) were measured using commercially available ELISA kits (Elabscience, Wuhan, China), following the manufacturers’ protocols. All assays were based on the sandwich ELISA principle, where specific antibodies pre-coated onto microplate wells captured the target analytes. Subsequently, biotinylated detection antibodies and Avidin-HRP conjugates (or HRP-conjugated antibodies) were added, forming an immune complex. After washing to remove unbound components, a substrate solution was added, producing a colorimetric reaction. The absorbance was measured spectrophotometrically at 450 ± 2 nm. The concentrations of the biomarkers were calculated by comparing the optical density (OD) of the samples to the standard curve. HOMA-IR is calculated by the equation HOMA-IR (Homeostatic Model of Insulin Resistance) = (Insulin (µU) * Glucose (mg/dl)) ÷ 405. Result: The result found a highly significant increase (p≤0.01) in leptin, C-peptide, and HOMA-IR (223.963±66.507, 123.614±32.939, and 2.137±1.059, respectively) in clinical atherosclerosis patients compared to the subclinical atherosclerosis group (93.112±12.853, 40.291±9.174, and 0.760±0.091, respectively). Significant increases (p≤0.01) in random glucose, insulin, and HbA1C and lipid profiles revealed significant increases (p≤0.01) in TC, TG, LDL, and VLDL in clinical atherosclerosis as compared to subclinical atherosclerosis. Leptin showed the highest diagnostic accuracy with an AUC of 99.111%, sensitivity of 91.121%, and specificity of 97.678% at a cutoff value of 125.148 pg/ml. Similarly, HOMA-IR also exhibited excellent predictive performance (AUC 97.037%, sensitivity 91.111%, specificity 97.778%), suggesting its strong association with advanced atherosclerotic changes. In contrast, HbA1c showed lower diagnostic power (AUC 68.370%, sensitivity 71.111%, specificity 60.000%), indicating it may be less reliable as a standalone biomarker for atherosclerosis.. Conclusion: The increase in serum Leptin and HOMA-IR in Atherosclerosis patients are related to early predicting cardiovascular complications.

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