Assessment of adiponectin and the risk of recurrent cardiovascular events in patients presenting with an acute coronary syndrome: Observations from the Pravastatin Or atorVastatin Evaluation and Infection Trial-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22)
Assessment of adiponectin and the risk of recurrent cardiovascular events in patients presenting with an acute coronary syndrome: Observations from the Pravastatin Or atorVastatin Evaluation and Infection Trial-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22)
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DOI：
10.1016/j.ahj.2011.02.014
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发表时间：
2011-06-01
影响因子：
4.8
通讯作者：
Morrow, David A.
中科院分区：
文献类型：
--
作者：
Wilson, Sean R.;Sabatine, Marc S.;Morrow, David A.
脂联素是一种脂肪细胞因子，由脂肪细胞分泌，在动脉粥样硬化、泡沫细胞形成和细胞粘附中发挥调节作用。在稳定的动脉粥样硬化中，血浆脂联素已被报道与心血管风险的增加和降低相关。最近的数据表明急性冠脉综合征（ACS）可能存在不一致的不良风险关系。因此，我们研究了脂联素与ACS患者心血管事件之间的关系。方法对3931例ACS后病情稳定的患者进行血浆脂联素测定，并评估其与2年预后的关系。随访患者的全因死亡和主要心血管事件。使用多变量Cox回归，我们调整了年龄、性别、种族、ACS类型、糖尿病、吸烟状况、甘油三酯、血压、体重指数、估计肾小球滤过率、治疗组（阿托伐他汀）、b型利钠肽和c反应蛋白。结果脂联素与年龄、糖尿病、体重指数、甘油三酯呈负相关（P < 0.001），与死亡（P = 0.01）、心肌梗死（P = 0.01）、心力衰竭（P < 0.001）呈正相关。在调整临床危险因素、b型利钠肽和c反应蛋白后，脂联素高于中位数（4,477 ng/mL）与死亡或心肌梗死（危险比1.58,95% CI 1.10-2.28, P = 0.013）和充血性心力衰竭（危险比2.17,95% CI 1.21-3.89, P = 0.010）的风险增加独立相关。结论：ACS后早期较高的脂联素浓度与较高的心血管事件复发风险独立相关。这一发现与在有动脉粥样硬化风险的患者中观察到的结果相反，表明有必要进行研究，以阐明稳定与不稳定冠状动脉疾病中脂联素的病理生物学差异。[J] .中国医学杂志，2011;31(1):397 - 397。
Background Adiponectin, an adipocytokine, is secreted by fatty cells and exerts a regulatory role in atherogenesis, modulating foam cell formation and cellular adhesion. In stable atherosclerosis, plasma adiponectin has been reported to be associated with both increased and decreased cardiovascular risk. Recent data have suggested a possible discordant adverse risk relationship in acute coronary syndrome (ACS). Therefore, we investigated the association between adiponectin and cardiovascular events in patients with ACS.Methods We measured plasma adiponectin in 3,931 patients stabilized following ACS and assessed the relationship with 2-year outcome. Patients were followed for all-cause death and major cardiovascular events. Using multivariable Cox regression, we adjusted for age, sex, race, ACS type, diabetes, smoking status, triglycerides, blood pressure, body mass index, estimated glomerular filtration rate, treatment group (atorvastatin), B-type natriuretic peptide, and C-reactive protein.Results Adiponectin correlated negatively with age, diabetes, body mass index, and triglycerides (each, P < .001) but showed a positive relationship with the risk of death (P = .01), myocardial infarction (P = .01), and heart failure (P < .001). After adjusting for clinical risk factors, B-type natriuretic peptide, and C-reactive protein, adiponectin greater than the median (4,477 ng/mL) was independently associated with an increased risk of death or myocardial infarction (hazard ratio 1.58, 95% CI 1.10-2.28, P = .013) and congestive heart failure (hazard ratio 2.17, 95% CI 1.21-3.89, P = .010).Conclusions Higher adiponectin concentrations early after ACS are independently associated with a higher risk of recurrent cardiovascular events. This finding is directionally opposite to that observed in patients at risk for atherosclerosis and reveals the need for investigation to elucidate differences in the pathobiology of adiponectin in stable versus unstable coronary artery disease. (Am Heart J 2011;161:1147-1155.e1.)