Abstract 16200: Specific Deleterious Effects of Adiponectin on Long-Term Outcome in Diabetic Patients With Advanced Coronary Artery Disease: A Case for Adiponectin Resistance
Adiponectin, an adipocyte specific cytokine associated with insulin sensitivity, exerts antiatherogenic effects. However, its association with major cardiovascular events (MACE) bears conflicting results, in particular in patients with insulin resistance. We investigated this issue in a population of 408 patients with advanced coronary artery disease (CAD) defined as the presence of at least one coronary artery occlusion and a 9-year follow-up.
The population was predominantly male (80.9%) with a mean age of 63±11 years. Baseline plasma concentrations of adiponectin were similar in patients with (6.73 (3.59-10.13) μg/mL) or without (6.31 (3.47-11.48) μg/mL) diabetes (defined as fasting glycaemia>1.1g/L or known history, n=184, 45.1%). We documented cardiovascular (CV) mortality (n=101, 24.8%) and MACE (combined CV mortality, non-fatal myocardial infarction and ischemic stroke, n=197, 48.3%). Using Cox regression proportional analysis, age and sex adjusted adiponectin was an independent predictor of CV mortality (per each 1 μg/mL increase in plasma adiponectin concentration, hazard ratio HR=1.06, 95%CI=1.03-1.09, p<0.0001) and MACE (HR=1.04, 95%CI=1.02-1.07, p=0.0004). Likewise, age and sex adjusted, diabetes mellitus was an independent predictor of CV mortality (HR 1.82, 95%CI (1.19-2.70), p=0.0049). In diabetic patients, the presence of a high adiponectin level (above median value) was associated with a marked increase in CV mortality rate (HR=2.79, 95%CI (1.61-4.83), p=0.0002, Figure). By contrast in non-diabetic patients the effect of a high adiponectin level on CV mortality was marginal (HR=1.69, 95%CI (0.89-3.22), p=0.11, Figure).
In conclusion, these results show that adiponectin concentrations could help to risk stratify diabetic patients with advanced CAD. They further suggest that the combination of adiponectin resistance and insulin resistance play a specific deleterious role in the history of patients with CAD.
- © 2013 by American Heart Association, Inc.