European Heart Journal Advance Access originally published online on June 9, 2008
European Heart Journal 2008 29(15):1923-1924; doi:10.1093/eurheartj/ehn246
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Association of adiponectin with adverse outcome in coronary artery disease patients: results from the AtheroGene study: reply
Johannes Gutenberg-University Mainz
Langenbeckstrasse 1
Mainz
Germany
Email: schnabelr{at}gmx.de
We thank Dr Ferrante et al.1 for their interest in our work. By enrolling consecutive cath lab patients in the AtheroGene cohort, we had the opportunity to evaluate adiponcetin concentrations across the entire range of coronary artery disease (CAD) patients. This may be seen as an advantage, but also implies heterogeneity of the cohort which we addressed by presenting our data in the more homogenous subgroups of patients with stable angina (SAP) and acute coronary syndrome (ACS). In ACS, we observe a similar magnitude and direction of association. Especially in the categorical analysis, it becomes obvious that high concentrations of adiponectin may be related to higher cardiovascular event rates that can be viewed as confirmatory.2 For survival analysis, we do provide the number of events, which shows, as expected, a higher event rate for ACS patients. These hypothesis generating results need to be prospectively confirmed in ACS cohorts.3
We did not exclude participants on the basis of B-type natriuretic peptide (BNP) concentrations. In Model 2 of the statistical regression analysis, adjusting for ACS, adiponectin concentrations remain related to outcome at the 0.05 level. Only after additional adjustment for BNP in the last model, the association becomes borderline when based on the statistical cut-off of 0.05. The effect size and direction remain approximately the same. Two reasons may, in part, account for this: (i) we did not have BNP measurements in all participants, which reduces the power to achieve a statistical threshold, (ii) a positive correlation between adiponectin and BNP is known,4 which often weakens the effect in a regression analysis.
The value of a biomarker can simplistically be seen as a clinical tool to provide diagnostic or prognostic information to help medical decision making or to provide mechanistic insights.5 As we point out, the benefit of our data should be seen in the confirmation and extension of recent evidence, that the biomarker adiponectin with a positive biological profile in experimental data, animal models, and human studies in individuals free of symptomatic cardiovascular disease seems to be associated with adverse outcome in manifest CAD when measured with a commercially available assay. This information, in a large epidemiological study, may help to better understand the complex pathophysiological role of adiponectin in health and disease.
References
- Schnabel R, Messow CM, Lubos E, Espinola-Klein C, Rupprecht HJ, Bickel C, Sinning C, Tzikas S, Keller T, Genth-Zotz S, Lackner KJ, Munzel TF, Blankenberg S. Association of adiponectin with adverse outcome in coronary artery disease patients: results from the AtheroGene study. Eur Heart J (2008) 29:649–657.
[Abstract/Free Full Text] - Cavusoglu E, Ruwende C, Chopra V, Yanamadala S, Eng C, Clark LT, Pinsky DJ, Marmur JD. Adiponectin is an independent predictor of all-cause mortality, cardiac mortality, and myocardial infarction in patients presenting with chest pain. Eur Heart J (2006) 27:2300–2309.
[Abstract/Free Full Text] - Pilz S, Maerz W, Weihrauch G, Sargsyan K, Almer G, Nauck M, Boehm BO, Winkelmann BR, Mangge H. Adiponectin serum concentrations in men with coronary artery disease: the LUdwigshafen RIsk and Cardiovascular Health (LURIC) study. Clin Chim Acta (2006) 364:251–255.[CrossRef][Web of Science][Medline]
- Kistorp C, Faber J, Galatius S, Gustafsson F, Frystyk J, Flyvbjerg A, Hildebrandt P. Plasma adiponectin, body mass index, and mortality in patients with chronic heart failure. Circulation (2005) 112:1756–1762.
[Abstract/Free Full Text] - Gerszten RE, Wang TJ. The search for new cardiovascular biomarkers. Nature (2008) 451:949–952.[CrossRef][Web of Science][Medline]
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