Brief Article
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World J Diabetes. Oct 15, 2013; 4(5): 219-225
Published online Oct 15, 2013. doi: 10.4239/wjd.v4.i5.219
High adiponectin levels fail to protect against the risk of hypertension and, in women, against coronary disease: involvement in autoimmunity?
Altan Onat, Mesut Aydın, Günay Can, Bayram Köroğlu, Ahmet Karagöz, Servet Altay
Altan Onat, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34335 Etiler, Istanbul, Turkey
Mesut Aydın, Department of Cardiology, Dicle University Medical Faculty, Diyarbakir 21280, Turkey
Günay Can, Department of Public Health, Cerrahpaşa Medical Faculty, Istanbul University, 34099, Istanbul, Turkey
Bayram Köroğlu, Servet Altay, Department of Cardiology, Siyami Ersek Center for Cardiovascular Surgery, 34668, Istanbul, Turkey
Ahmet Karagöz, Section of Cardiology, Giresun Eğitim Hospital, 28000 Giresun, Turkey
Author contributions: Onat A designed the study and wrote the manuscript; Aydın M, Karagöz A, Altay S and Köroğlu B collected data, revised critically for intellectual content and approved the final version; Can G provided data analyses and approved the final version.
Supported by The Turkish Society of Cardiology
Correspondence to: Altan Onat, Professor, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Nisbetiye cad. 59/24, 34335 Etiler, Istanbul, Turkey. alt_onat@yahoo.com.tr
Telephone: +90-212-3516217 Fax: +90-212-2211754
Received: May 30, 2013
Revised: August 16, 2013
Accepted: August 28, 2013
Published online: October 15, 2013
Processing time: 138 Days and 15.3 Hours
Abstract

AIM: To investigate whether serum adiponectin protects against cardiometabolic risk in a population sample with prevailing metabolic syndrome.

METHODS: Middle-aged adults representative of a general population with baseline circulating adiponectin measurements (n = 1224) were analyzed prospectively at a mean of 3.8 years’ follow-up, using continuous values or sex-specific tertiles. Total adiponectin was assayed by an ELISA kit. Type-2 diabetes was identified by criteria of the American Diabetes Association. Hypertension was defined as a blood pressure ≥ 140 mmHg and/or ≥ 90 mmHg and/or use of antihypertensive medication. Outcomes were predicted using Cox proportional hazards regression analysis in models that were controlled for potential confounders.

RESULTS: In models of multiple linear regression, sex hormone-binding globulin, fasting insulin (inverse) and, in men, age were significant independent covariates of serum adiponectin which further tended in women to be positively associated with serum creatinine. Cox regression analyses for incident coronary heart disease (CHD), adjusted for sex, age, non-HDL cholesterol, waist circumference and C-reactive protein, revealed significant inverse association with adiponectin tertiles in men but not women (HR = 0.66; 95%CI: 0.32-1.38 for highest tertile). Cox regression for type-2 diabetes in a similar model (wherein glucose replaced non-HDL cholesterol), adiponectin tertiles appeared to protect in each gender. HR for incident hypertension roughly displayed unity in each of the adiponectin tertiles (P-trend = 0.67).

CONCLUSION: High adiponectin levels failed to protect against the development of hypertension and, in women, against CHD, presumably paralleling impairment in renal function as well. Involvement of adiponectin in autoimmune complex with loss of antioxidative-antiatherogenic properties may be underlying.

Keywords: Adiponectin; Antioxidative function; Coronary heart disease; Creatinine; Type-2 diabetes; Hypertension

Core tip: The issue of whether serum adiponectin protects against cardiometabolic risk in people prone to metabolic syndrome was studied in 1224 Turkish adults at a mean of 3.8 years’ follow-up. High adiponectin levels were surprisingly positively associated independently with serum creatinine in women and further failed to protect against the development of hypertension in both sexes. In multivariable adjusted Cox proportional hazards regression analyses, protection against type-2 diabetes was apparent, but women were not protected against incident coronary heart disease by high serum adiponectin. Involvement of circulating adiponectin in autoimmune complex with loss of mainly antioxidative properties may be underlying.