Published online before print September 12, 2005, doi: 10.1161/CIRCULATIONAHA.104.530972
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(Circulation. 2005;112:1756-1762.)
© 2005 American Heart Association, Inc.
Heart Failure |
Plasma Adiponectin, Body Mass Index, and Mortality in Patients With Chronic Heart Failure
From the Department of Cardiology and Endocrinology, Frederiksberg University Hospital (C.K., P.H.), Copenhagen, Denmark; Department of Endocrinology, Herlev University Hospital (J. Faber), Copenhagen, Denmark; Department of Cardiology, Gentofte University Hospital (S.G.), Gentofte, Denmark; Department of Cardiology, State University Hospital (Rigshospitalet) (F.G.), Copenhagen, Denmark; and Medical Research Laboratories, Medical Department (Diabetes and Endocrinology), Aarhus University Hospital (J. Frystyk, A.F.), Aarhus, Denmark.
Correspondence to Caroline Kistorp, MD, Department of Cardiology and Endocrinology, Frederiksberg University Hospital, 57 Nordre Fasanvej, DK-2000 Frederiksberg, Denmark. E-mail cnkistorp{at}dadlnet.dk
Received December 20, 2004; revision received June 1, 2005; accepted June 24, 2005.
Background— Recent studies have suggested that higher body mass index (BMI) is associated with improved prognosis in chronic heart failure (CHF). The adipocytokine adiponectin is inversely associated with BMI, and in healthy subjects, low adiponectin is a predictor of mortality. In a prospective study, we therefore evaluated the association between plasma adiponectin levels and mortality among patients with CHF.
Methods and Results— In 195 CHF patients (age 69.3±10.2 years, BMI 27.3±5.2 kg/m2, left ventricular ejection fraction 30±8.9%, mean±SD), plasma adiponectin and N-terminal pro brain natriuretic peptide (NT-proBNP) were measured at baseline. Adiponectin was positively associated with NT-proBNP (ß=0.47, P<0.001), and both biomarkers were negatively associated with BMI (ß=–0.43, P<0.001 for adiponectin and ß=–0.38, P<0.001 for NT-proBNP, respectively) During a median follow-up of 2.6 years, 46 (23.5%) of the patients died. After adjustment for clinical variables associated with CHF severity (age, systolic blood pressure, left ventricular ejection fraction <25%, duration of CHF, and creatinine clearance) and for NT-proBNP, the hazard ratio of mortality for values in the 2 upper tertiles relative to the lowest tertile of adiponectin was 3.23 (P=0.032). BMI predicted mortality independently of clinical parameters of CHF severity (hazard ratio=0.63, P=0.012), but this association became insignificant after additional adjustment for NT-proBNP (hazard ratio=0.74, P=0.13).
Conclusions— A high adiponectin level was a predictor of mortality, independent of risk markers of CHF severity, presumably because of its role as a marker for wasting. BMI was also associated with mortality, but a part of this relation may be mediated by adiponectin and NT-proBNP levels.
Key Words: adiponectin • body mass index • natriuretic peptides • heart failure
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