Abstract 16751: Baseline Adiponectin Concentration and Clinical Outcomes Among Patients With Diabetes and Recent Acute Coronary Syndrome in the EXAMINE Trial
Introduction: Adiponectin is a pleiotropic adipocytokine with a strong inverse (protective) association with obesity, diabetes (DM), and cardiovascular outcomes in stable patients. In a prior study, this relationship appeared to be reversed in the setting of acute coronary syndrome (ACS). Given this apparent discordance, we investigated in an additional trial the association between adiponectin and cardiovascular (CV) outcomes among patients with DM and recent ACS.
Methods: We analyzed baseline adiponectin concentration and CV outcomes in 5,213 patients with DM enrolled 15 to 90 days (median 45 days) after ACS in the EXAMINE trial of alogliptin vs placebo. Adiponectin concentration was categorized by quartiles. Event rates at 18 months are reported.
Results: The median baseline adiponectin concentration was 5.2 μg/mL (3.4-7.9 μg/mL). Mean HbA1c was 8.0%. In the Kaplan-Meier analysis, baseline adiponectin level in the highest quartile (Q4) identified patients with significantly higher rates of CV death (8.4% vs 1.7% P<0.0001), hospitalization for heart failure (7.5% vs 1.7% P<.0001), and all-cause mortality (10.8% vs 2.4% P<0.0001) compared to the lowest quartile (Q1) (Figure). After adjusting for age, sex, index event, heart failure, eGFR, and hypertension, adiponectin concentration in Q4 remained associated with an increased risk of CV death (HR 2.43 [1.52, 3.88]), hospitalization for heart failure (HR 2.44 [1.47, 4.05]), and all-cause mortality (HR 2.45 [1.65, 3.64]). There was no significant difference in the rate of MI (HR 0.71 [0.51, 1.00]) or stroke (HR 1.23 [0.72, 2.12]).
Conclusions: In this contemporary population of patients with DM and recent ACS, adiponectin concentration was independently associated with increased risk of CV death, hospitalization, and all-cause mortality. The relationship between adiponectin and CV outcomes is complex, differing between patients with unstable and stable ischemic heart disease, and deserves further study.
Author Disclosures: B.A. Bergmark: None. C.P. Cannon: Research Grant; Modest; Accumetrics. Research Grant; Significant; AstraZeneca, Takeda, Boerhinger Ingelheim, Merck, GlaxoSmithKline, Arisaph, Janssen, Regeneron, Sanofi. Consultant/Advisory Board; Modest; Takeda, Boerhinger Ingelheim, Kowa, Essentialis, Merck, GlaxoSmithKline, Bristol-Myers Squibb, Alnylam, Pfizer, CSL Behring. Consultant/Advisory Board; Significant; Lipimedix, Regeneron, Sanofi. Other; Modest; AstraZeneca (Travel support), Boerhinger Ingelheim (Travel Support), Accumetrics, CSL Behring. W.B. White: Consultant/Advisory Board; Modest; Takeda, Ardea Biosciences, AstraZeneca, Dendreon Group, Forest Research Institute, Roche Inc, St. Jude Medical, Teva Pharmaceuticals. P. Jarolim: Research Grant; Significant; Abbott Laboratories, Amgen, Inc., AstraZeneca, Beckman Coulter, Daiichi-Sankyo, Inc., GlaxoSmithKline, Merck & Co, Inc., Roche Diagnostic Corporation, Takeda Global Research and Development Center, Waters Technologies Corporation. D.A. Morrow: Research Grant; Significant; Abbott Laboratories, Amgen, Inc.; AstraZeneca Pharmaceuticals LP; Daichii Sankyo, Inc.; Eisai Co., Ltd, GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C, Eli Lilly and Co, Amgen, AstraZeneca, Daiichi Sankyo Co Ltd, GlaxoSmithKline, Merck and Co, Novartis Pharmaceuticals, Roche Diagnostics, Takeda. Consultant/Advisory Board; Modest; Abbott Laboratories, DiaDexus, Eli Lilly and Co, Gilead, Merck, Roche Diagnostics.
- © 2016 by American Heart Association, Inc.