Plasma adiponectin for prediction of cardiovascular events and mortality in high-risk patients
Plasma adiponectin for prediction of cardiovascular events and mortality in high-risk patients
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DOI：
10.1210/jc.2007-2405
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发表时间：
2008-09-01
影响因子：
5.8
通讯作者：
Rossi, Gian Paolo
中科院分区：
文献类型：
--
作者：
Maiolino, Giuseppe;Cesari, Maurizio;Rossi, Gian Paolo
背景：脂联素（一种具有抗动脉粥样硬化、抗炎和胰岛素增敏作用的脂肪细胞因子）的血浆水平的预后价值存在争议。目的：本研究的目的是调查血浆脂联素水平是否可以预测高危冠状动脉疾病 (CAD) 患者的心血管 (CV) 事件和死亡率。设计、设置、参与者和主要结果指标：我们测量血浆脂联素并检查其对发病率的影响冠状动脉粥样硬化研究中遗传和环境因素的 712 名高危患者因疑似 CAD 接受了冠状动脉造影，在所有潜在相关背景协变量的背景下，随访时心血管死亡和事件的情况。根据人群血浆脂联素中位数（6.38 μg/ml，四分位数范围 4.2-10.2），我们将患者分为高血浆脂联素亚组和低血浆脂联素亚组。经过中位随访 3.8 年（四分位间距 3.3-4.3 年）后，100% 的患者获得了结果数据，并记录了 45 例心血管死亡（6.4%）。 Kaplan-Meier 分析出乎意料地显示，高血浆脂联素患者的心血管死亡率高于低血浆脂联素患者。相比之下，考虑了潜在混杂因素（包括正在进行的药物治疗）的多变量 Cox 回归分析显示，血浆脂联素对心血管死亡没有影响。使用考虑所有相关协变量和医疗治疗率的倾向评分获得了类似的阴性结果，这在高血浆脂联素组和低血浆脂联素组之间有所不同。 结论：在高危 CAD 患者中，血浆脂联素高于中位数（6.38 μg/ml）意味着心血管死亡风险更高。然而，当考虑高血浆脂联素组和低血浆脂联素组之间不同的相关协变量时，这种关联减弱，表明血浆脂联素与其他协变量的聚集可以消除其对心血管预后的影响。
Context: The prognostic value of plasma levels of adiponectin, an adipocytokine with antiatherogenic, antiinflammatory, and insulin-sensitizing effects, is contentious.Objective: The objective of the study was to investigate whether plasma adiponectin levels predict cardiovascular ( CV) events and mortality in high-risk coronary artery disease ( CAD) patients.Design, Setting, Participants, and Main Outcome Measure: We measured plasma adiponectin and examined its impact on the incidence of CV deaths and events at follow-up in the context of all potentially relevant background covariates in 712 high-risk patients of the Genetic and ENvironmental factors in Coronary Atherosclerosis study who underwent coronary angiography for suspected CAD. Based on the population plasma adiponectin median ( 6.38 mu g/ml, interquartile range 4.2-10.2), we split the patients in a high-and a low-plasma adiponectin subgroup. After a median follow-up of 3.8 years ( interquartile range 3.3-4.3 yr), outcome data were obtained in 100% of the patients and 45 CV deaths (6.4%) were recorded. Kaplan-Meier analysis unexpectedly showed a higher CV death rate in high-plasma adiponectin than low-plasma adiponectin patients. By contrast, multivariate Cox regression analysis, in which potential confounders, including ongoing medical treatment, were considered, showed no impact of plasma adiponectin on CV death. Similar negative results were obtained using the propensity score that considered all relevant covariables and medical treatment rate, which differed between the high- and low-plasma adiponectin group.Conclusions: In high- risk CAD patients, plasma adiponectin above the median ( 6.38 mu g/ml) implies a paradoxical higher risk of CV death. However, when relevant covariates that differ between high- and low-plasma adiponectin groups are considered, this association wanes, indicating that the clustering of plasma adiponectin with other covariates can abolish its impact on CV prognosis.