CLINICAL RESEARCH: CORONARY ARTERY DISEASE
Serum Concentrations of Adiponectin and Risk of Type 2 Diabetes Mellitus and Coronary Heart Disease in Apparently Healthy Middle-Aged Men
Results From the 18-Year Follow-Up of a Large Cohort From Southern Germany
Wolfgang Koenig, MD, FACC*,*,
Natalie Khuseyinova, MD*,
Jens Baumert, PhD ,
Christa Meisinger, MD, MPH, and
Hannelore Löwel, MD
* Department of Internal Medicine II—Cardiology, University of Ulm Medical Center, Ulm, Germany
GSF - National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany
MONICA/KORA Myocardial Infarction Registry, Augsburg Central Hospital, Augsburg, Germany.
Manuscript received April 6, 2006;
revised manuscript received June 7, 2006,
accepted June 12, 2006.
* Reprint requests and correspondence: Dr. Wolfgang Koenig, Department of Internal Medicine II—Cardiology, University of Ulm Medical Center, Robert-Koch Str. 8, D – 89081 Ulm, Germany. (Email: wolfgang.koenig{at}uniklinik-ulm.de).
OBJECTIVES: We sought to assess the association between serum concentrations of adiponectin and long-term risk of type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) in initially healthy middle-aged men within the same representative population in Augsburg, southern Germany.
BACKGROUND: It has been postulated that high serum concentrations of adiponectin, an emerging biomarker that is linked to insulin resistance and endothelial dysfunction, may be protective against T2DM and CHD.
METHODS: Serum concentrations of adiponectin were determined in apparently healthy middle-aged men, sampled from the general population in 1984/1985 and followed until 2002. During this period, 115 of 887 men had a newly diagnosed T2DM, and 126 of 937 men suffered from a CHD event.
RESULTS: In a Cox model, after multivariable adjustment for cardiovascular risk factors, the hazard ratio of incident T2DM, comparing extreme tertiles of the adiponectin distribution, was 0.55 (95% confidence interval [CI], 0.35 to 0.89), and for incident CHD it was 0.62 (95% CI, 0.39 to 0.98). Further adjustment for high-density lipoprotein cholesterol (HDL-C) attenuated the association, which became formally non-significant. In joint analysis, men with low adiponectin and low HDL-C values showed a 2.63 times (95% CI, 1.66 to 4.15) increased incidence of T2DM and a 1.91 times (95% CI, 1.20 to 3.04) increased incidence of CHD after multivariable adjustment in comparison with men with high HDL-C and high adiponectin.
CONCLUSIONS: For patients with low HDL-C values, additional measurement of adiponectin may be helpful to identify individuals at very high risk for T2DM and CHD.
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Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | Apo = apolipoprotein | | ARIC = Atherosclerosis Risk In Communities Study | | BMI = body mass index | | CHD = coronary heart disease | | CI = confidence interval | | CRP = C-reactive protein | | CV = coefficient of variation | | ELISA = enzyme-linked immunosorbent assay | | HDL-C = high-density lipoprotein cholesterol | | HPFU = Health Professionals’ Follow-Up study | | HR = hazard ratio | | KORA = KOoperative Gesundheitsforschung in der Region Augsburg | | LPL = lipoprotein lipase | | Lp-PLA2 = lipoprotein-associated phospholipase A2 | | MI = myocardial infarction | | MONICA = MONItoring of trends and determinants in CArdiovascular disease | | RR = relative risk | | SMC = smooth muscle cell | | TC = total cholesterol | | T2DM = type 2 diabetes mellitus |
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