Total adiponectin and risk of symptomatic lower extremity peripheral artery disease in men.
Total adiponectin and risk of symptomatic lower extremity peripheral artery disease in men.
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DOI：
10.1161/atvbaha.112.301089
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发表时间：
2013-05
期刊：
影响因子：
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通讯作者：
Mukamal KJ
中科院分区：
文献类型：
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作者：
Joosten MM;Joshipura KJ;Pai JK;Bertoia ML;Rimm EB;Mittleman MA;Mukamal KJ
在健康个体中，脂联素浓度较低与随后的冠心病风险有关。对于系统性动脉粥样硬化（如外周动脉疾病（PAD））的发展是否存在类似的关系尚不确定。我们研究了总脂联素与下肢PAD风险之间的关系。我们对18，225名健康专业人员随访研究的男性参与者进行了一项前瞻性巢式病例对照研究，这些参与者在抽血时（1993-1995年）没有被诊断为心血管疾病。在14年的随访中，143名男性患上了PAD。使用风险集抽样，以3：1的比例选择对照组，并在年龄、吸烟状态、空腹状态和抽血日期方面进行匹配（n=429）。与对照组相比，病例组的基线脂联素浓度中位数（四分位距）较低（4.1 [3.2-5.5] vs. 5.4 [3.8-7.5] μg/mL; P<0.001）。在控制基线心血管危险因素后，使用限制样条条件Logistic回归，脂联素浓度与PAD风险的全谱呈明显的对数线性负相关。校正心血管危险因素后，脂联素与脂联素自然对数转换值每增加一个标准差，PAD风险降低42%相关（相对风险[RR]，0.58; 95%置信区间[CI]，0.45-0.74）。进一步考虑高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、C反应蛋白和胱抑素C后，RR降低（RR，0.68; 95% CI，0.51-0.92）。血红蛋白A1 c、甘油三酯和γ-谷氨酰转移酶的额外调整对这种关联几乎没有影响（RR，0.68; 95% CI，0.50-0.92）。总脂联素与男性有症状下肢PAD风险呈负相关。
Lower concentrations of adiponectin have been linked to subsequent risk of coronary heart disease in healthy individuals. Whether similar relationships exist for the development of systemic atherosclerosis, such as peripheral artery disease (PAD), is uncertain. We investigated the association between total adiponectin and risk of lower extremity PAD. We performed a prospective, nested case-control study among 18,225 male participants of the Health Professionals Follow-up Study who were free of diagnosed cardiovascular disease at the time of blood draw (1993-1995). During 14 years of follow-up, 143 men developed PAD. Using risk set sampling, controls were selected in a 3:1 ratio and matched on age, smoking status, fasting status, and date of blood draw (n=429). Median (interquartile range) adiponectin concentrations at baseline were lower among cases compared to controls (4.1 [3.2-5.5] vs. 5.4 [3.8-7.5] μg/mL; P<0.001). A log-linear inverse association was evident over the full spectrum of adiponectin concentrations with PAD risk after controlling for baseline cardiovascular risk factors using restricted spline conditional logistic regression. Adiponectin was associated with a 42% lower risk of PAD per SD increase in natural log-transformed adiponectin (Relative risk [RR], 0.58; 95% confidence interval [CI], 0.45-0.74) after adjustment for cardiovascular risk factors. The RR was attenuated (RR, 0.68; 95% CI, 0.51-0.92) after further accounting for high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, C-reactive protein, and cystatin C. Additional adjustment for hemoglobin A1c, triglycerides, and gamma-glutamyltransferase had little impact on this association (RR, 0.68; 95% CI, 0.50-0.92). Total adiponectin is inversely associated with risk of symptomatic lower extremity PAD in men.