Relation of Serum Adiponectin Levels to Number of Traditional Atherosclerotic Risk Factors and All-Cause Mortality and Major Adverse Cardiovascular Events (From the Copenhagen City Heart Study)

Study Questions:

What is the association of adiponectin levels with coronary artery disease (CAD) risk factors and adverse cardiovascular (CV) events?

Methods:

Plasma adiponectin was measured in 5,624 randomly selected men and women from the community without CV disease. Median follow-up time was 7.8 years. The endpoint was all-cause mortality (n = 801), and the combined endpoint was major adverse cardiac events (MACE), consisting of CV mortality, nonfatal myocardial infarction, or ischemic stroke (n = 502).

Results:

High adiponectin was inversely associated with an increasing number of traditional CV risk factors (p < 0.0001). Mean adiponectin concentrations were 10.0 mg/L for persons with no CV risk factors present versus 8.1 mg/L for persons with four CV risk factors. After adjustment for confounding risk factors, adiponectin remained an independent predictor of death and MACE. The hazard ratio for each increase in adiponectin of 5 mg/L for death and MACE was 1.20 (p < 0.0001) and 1.14 (p < 0.0001), respectively.

Conclusions:

The authors concluded that an increasing number of risk factors for CV disease is associated with decreased plasma adiponectin. High plasma adiponectin independently predicted death and MACE in a large community-based population.

Perspective:

Adiponectin is the most abundant circulating adipokine. Interestingly, its concentration has previously been reported to be inversely related to adiposity, and it has been shown to exhibit insulin-sensitizing and cardioprotective effects. However, several studies have linked higher levels of adiponectin with adverse CV outcomes. This study supports this adiponectin paradox. The explanation for these complex associations is unclear, but the authors suggest that this could represent a scenario analogous to insulin in which adiponectin resistance occurs. In addition, different molecular forms of adiponectin with different activities could contribute to the paradox.

Keywords: Biological Markers, Adiponectin, Cardiovascular Diseases


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