European Heart Journal Advance Access originally published online on September 9, 2008
European Heart Journal 2008 29(20):2579-2580; doi:10.1093/eurheartj/ehn396
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Adiponectin and prognostic outcome in patients with coronary artery disease: reply
Department of Nephrology
Klinikum rechts der Isar
Technische Universitaet Muenchen
Ismaningerstr. 22
D-81675 Munich
Germany
Tel: +49 89 4140 6704
Fax: +49-89 4140 4741
Email: maximilian.eynatten{at}lrz.tum.de
Division of Clinical Epidemiology and Aging Research
German Cancer Research Center
Heidelberg
Germany
Division of Clinical Epidemiology and Aging Research
German Cancer Research Center
Heidelberg
Germany
The letter by Cesari et al.1 refers to yet unpublished data on the association between plasma adiponectin and prognostic outcome in patients with coronary heart disease (CHD). The authors exclusively focused on total adiponectin levels and did not consider its multimeric isoforms, such as the high-molecular weight isoform. In accordance with our study,2 adiponectin levels did not yield additional predictive value for secondary cardiovascular disease events in addition to traditional cardiovascular risk factors after appropriate adjustment for covariates and consequently may not be regarded as an independent biomarker for future risk in patients with prevalent CHD. However, we like to emphasize distinct differences regarding patient selection and design of the two studies resulting in important consequences for data interpretation.
We recruited incident CHD patients out of an in-hospital rehabilitation programme only if they were admitted within 3 months after the acute event.2 As secondary prevention efforts usually start immediately after the incident event in the acute hospital, we targeted patients at the earliest stage for a possible secondary outcome follow-up. Impaired left ventricular function (LVF) is a common clinical complication in advanced CHD, substantially associated with disease morbidity and mortality. Compared with our cohort, patients in the study by Cesari et al. were presumably in more advanced stages of CHD with already impaired LVF. This may explain the increased CV death rate in their study. Furthermore, they reported a significant positive association between adiponectin and CV death, which was previously shown by other studies comprising patients with chronic heart failure (CHF).3 In an earlier work, we found also a positive association between adiponectin and a marker of heart failure.4 However, it is generally accepted that several traditional risk factors require different interpretation in patients with CHF, and high adiponectin in CHF patients could simply be a risk marker for severe complications of CHD, such as heart failure. In our cohort, the majority of patients had normal LVF, a possible reason for the lack of a positive association between adiponectin and CHD death in the study. Nevertheless, the concordant findings of Cesari et al. and our study clearly suggest that adiponectin may not emerge as a promising target for secondary risk measures, neither in incident CHD nor any later in the course of coronary atherosclerosis.
We fully agree with Cesari et al. that traditional risk factors should be targeted first and that the individual course of CHD and related complications should have a major impact on planning secondary prevention strategies. Adiponectin, however, still has the potential to claim an important role in CHD risk assessment. Adiponectin has several anti-inflammatory and anti-atherosclerotic properties that affect the very early stages of atherosclerosis. Consequently, convincing risk prediction for adiponectin in primary CHD prevention was reported for apparently healthy males5 and patients with type 2 diabetes.6 Therefore, future interventional studies have to identify high-risk patients for CHD and target circulating adiponectin levels to further elucidate the causal role of adiponectin in atherogenesis.
References
- Cesari M, Rossi GP. Atherogenic dyslipidemia but not total- and high-molecular weight adiponectin are associated with the prognostic outcome in patients with coronary heart disease (Letter). Eur Heart J (2008) (in press).
- von Eynatten M, Hamann A, Twardella D, Nawroth PP, Brenner H, Rothenbacher D. Atherogenic dyslipidaemia but not total- and high-molecular weight adiponectin are associated with the prognostic outcome in patients with coronary heart disease. Eur Heart J (2008) 29:1307–1315.
[Abstract/Free Full Text] - 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] - von Eynatten M, Hamann A, Twardella D, Nawroth PP, Brenner H, Rothenbacher D. Relationship of adiponectin with markers of systemic inflammation, atherogenic dyslipidemia and heart failure in patients with coronary heart disease. Clin Chem (2006) 52:853–859.
[Abstract/Free Full Text] - Pischon T, Girman CJ, Hotamisligil GS, Rifai N, Hu FB, Rimm EB. Plasma adiponectin levels and risk of myocardial infarction in men. JAMA (2004) 291:1730–1737.
[Abstract/Free Full Text] - Schulze MB, Shai I, Rimm EB, Li T, Rifai N, Hu FB. Adiponectin and future coronary heart disease events among men with type 2 diabetes. Diabetes (2005) 54:534–539.
[Abstract/Free Full Text]
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