Adiponectin is associated with increased mortality and heart failure in patients with stable ischemic heart disease: data from the Heart and Soul Study.
Adiponectin is associated with increased mortality and heart failure in patients with stable ischemic heart disease: data from the Heart and Soul Study.
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DOI：
10.1016/j.atherosclerosis.2011.11.038
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发表时间：
2012-02
期刊：
影响因子：
5.3
通讯作者：
Whooley MA
中科院分区：
文献类型：
--
作者：
Beatty AL;Zhang MH;Ku IA;Na B;Schiller NB;Whooley MA
血清脂联素可预防缺血性心脏病(IHD)。然而，在现有的IHD患者中，脂联素水平较高与较差的预后有矛盾的关联。我们通过评估脂联素与现有IHD患者心血管事件的关系来研究这一悖论。我们用负荷超声心动图测定了981名稳定的IHD门诊患者的血清总脂联素和心脏疾病严重程度，这些患者在2000年9月至2002年12月期间被招募参加心脏与灵魂研究。随后的心力衰竭住院、心肌梗死和死亡被记录下来。在平均7.1年的随访中，脂联素水平最高的四分位数的患者比那些脂联素水平最低的四分位数的患者更有可能因心力衰竭住院(23%对13%；人口统计学调整的风险比(HR)1.63，95%可信区间(CI)1.04-2.56，p=0.03)或死亡(49%对31%；HR 1.67，95%CI 1.24-2.26，p<；0.008)，但并不更有可能发生心肌梗死(12%对17%；HR为0.64，95%CI为0.38-1.06，P=0.08)。脂联素水平最高四分位数的参与者中，56%(136/245)出现心肌梗死、心力衰竭或死亡的综合结果，而脂联素水平最低四分位数(HR1.54，95%可信区间1.31-2.21，p<；0.002)的参与者中，这一比例为38%(94/246)。调整左心室射血分数、舒张期功能不全、诱导性缺血、C反应蛋白和NT-proBNP可减弱脂联素升高与后续事件风险增加之间的关联(HR 1.43，95%CI 0.98-2.09 p=0.06)。在现有的IHD患者中，脂联素浓度较高与心力衰竭和死亡率相关。
Serum adiponectin protects against incident ischemic heart disease (IHD). However, in patients with existing IHD, higher adiponectin levels are paradoxically associated with worse outcomes. We investigated this paradox by evaluating the relationship between adiponectin and cardiovascular events in patients with existing IHD. We measured total serum adiponectin and cardiac disease severity by stress echocardiography in 981 outpatients with stable IHD who were recruited for the Heart and Soul Study between September 2000 and December 2002. Subsequent heart failure hospitalizations, myocardial infarction, and death were recorded. During an average of 7.1 years of follow-up, patients with adiponectin levels in the highest quartile were more likely than those in the lowest quartile to be hospitalized for heart failure (23% vs. 13%; demographics-adjusted hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.04–2.56, p=0.03) or die (49% vs. 31%; HR 1.67, 95% CI 1.24–2.26, p<0.008), but not more likely to have a myocardial infarction (12% vs. 17%; HR 0.64, 95% CI 0.38–1.06, p=0.08). The combined outcome of myocardial infarction, heart failure, or death occurred in 56% (136/245) of participants in the highest quartile of adiponectin vs. 38% (94/246) of participants in the lowest quartile (HR 1.54, 95% CI 1.31–2.21, p<0.002). Adjustment for left ventricular ejection fraction, diastolic dysfunction, inducible ischemia, C-reactive protein, and NT-proBNP attenuated the association between higher adiponectin and increased risk of subsequent events (HR 1.43, 95% CI 0.98–2.09 p=0.06). Higher concentrations of adiponectin were associated with heart failure and mortality among patients with existing IHD.
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