Abstract 1188: Association of Adiponectin with adverse Outcome in manifest Coronary Artery Disease
Background In primary prevention the adipocytokine adiponectin seems to be protective against diabetes mellitus and cardiovascular disease. Data in patients with manifest coronary artery disease (CAD) are scant stimulating the investigation of the association of adiponectin levels and cardiovascular outcome in CAD patients.
Methods In 1890 consecutive patients with documented CAD (1130 with stable angina and 760 with acute coronary syndrome (ACS)) baseline concentrations of adiponectin were measured by radio immuno assay. During a median follow-up of 2.5 years cardiovascular events were registered (cardiovascular deaths=70; non-fatal myocardial infarctions=46 ).
Results Adiponectin concentrations were elevated in patients with future CV events (10.7 (7.0/17.9) vs. 9.1 (6.7/13.1) μg/mLL). Kaplan-Meier survival analysis showed a stepwise decrease in event-free survival across quartiles of adiponectin baseline concentration in both subgroups of patients (stable angina p=0.075 and acute coronary syndrome p=0.254). A strong correlation of adiponectin with high density cholesterol (r=0.39), and a negative relation to triglycerid levels (r=-0.22) could be described. An increase of one interquartile distance in adiponectin concentration was associated with a 1.17-fold risk for future cardiovascular events (P=0.013), in B-type natriuretic peptide (BNP) it meant a 1.13-fold risk (P<0.001). In the overall patient group this risk association remained robust after adjustment for classical risk factors, clinical presentation and cardiac medication. Only after adjustment for BNP adiponectin lost its predictive value.
Conclusion In contrast to primary prevention examinations, the current prospective study for the first time demonstrates that adiponectin is associated with adverse cardiovascular outcome in patients with manifest CAD disease. Adiponectin levels provide relevant additional information for risk prediction to classical risk factors, but its predictive values is less strong than the predictive value of BNP.