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

Abstract

Abstract Purpose:The study aimed to investigate the potential effect of Antithrombin Ⅲ between chronic renal insufficiency and coronary artery disease in T2DM patients. Methods:We collected data of T2DM patients hospitalized in ZhongDa Hospital affiliated with Southeast University. Relationships between renal function, Antithrombin Ⅲ, and coronary artery disease were explored using multivariate regression models. Multiplicative and additive interaction analysis was investigated. Bootstrap mediation analysis was utilized to investigate the role of Antithrombin Ⅲ. Results:A total of 4,238 patients were included, among which the coronary artery disease prevalence was 23.8%. Lower levels of renal function and Antithrombin Ⅲ were observed in patients with coronary artery disease (P<0.05). In adjusted models, each 10-unit increase in Antithrombin Ⅲ was associated with an 8.3% (95%CI: 3.2%~13.1%; P<0.05) decrease in coronary artery disease risk. Patients with low levels of both eGFR and Antithrombin Ⅲ were in the highest risk (OR=1.45; 95%CI: 1.10-1.90, P<0.05) of coronary artery disease, while no multiplicative and additive interaction effects were significant. Bootstrap mediation analysis estimated that Antithrombin Ⅲ mediated approximately 4.40% of the effect of chronic renal insufficiency on coronary artery disease risk. Conclusion:Antithrombin Ⅲ may serve as a mediator between chronic renal insufficiency and coronary artery disease, providing mechanistic insights into a new clinical observation.