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Adiponectin and Future Coronary Heart Disease Events Among Men With Type 2 Diabetes

¹ Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
² Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
³ S. Daniel Abraham International Center for Health and Nutrition, Department of Epidemiology, Ben-Gurion University, Beer-Sheva, Israel
⁴ Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
⁵ Department of Laboratory Medicine, Children’s Hospital and Harvard Medical School, Boston, Massachusetts

Adiponectin, predominantly synthesized in the adipose tissue, seems to have substantial anti-inflammatory properties and to be a major modulator of insulin resistance and dyslipidemia, mechanisms that are associated with an increased atherosclerotic risk in diabetic patients. However, it is unknown whether higher levels of adiponectin are associated with a reduced risk for coronary heart disease (CHD) among diabetic individuals. We investigated the association between plasma adiponectin levels and incidence of CHD among 745 men with confirmed type 2 diabetes in the Health Professionals Follow-up Study. Participants were aged 46–81 years and were free of diagnosed cardiovascular disease at the time of blood draw in 1993/1994. During an average of 5 years of follow-up (3,980 person-years), we identified 89 incident cases of CHD (19 myocardial infarction and 70 coronary artery bypass surgery), confirmed by medical records. Levels of adiponectin were inversely associated with BMI and directly associated with age, alcohol intake, and duration of diabetes (P < 0.05). After adjustment for age, BMI, smoking, alcohol consumption, duration of diabetes, and other lifestyle factors, adiponectin was associated with a decreased risk for CHD events. The multivariate relative risk for CHD for a doubling of adiponectin was 0.71 (95% CI 0.53–0.95). Further adjustment for HDL cholesterol attenuated this association (0.78 [0.57–1.06]). The inverse association between adiponectin and CHD was consistent across strata of aspirin use, family history of myocardial infarction, alcohol consumption, insulin use, duration of diabetes, and levels of HbA_1c, triglycerides, C-reactive protein, and HDL cholesterol. Our study suggests that increased adiponectin levels are associated with a moderately decreased CHD risk in diabetic men. This association seems to be mediated in part by effects of adiponectin on HDL cholesterol levels.

Abbreviations: CHD, coronary heart disease; CRP, C-reactive protein; sTNFR2, soluble fractions of tumor necrosis factor- receptor 2

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