ADIPOQ and adiponectin: the common ground of hyperglycemia and coronary artery disease?

Abstract

SUMMARYPlasma adiponectin and the coding gene for adiponectin, ADIPOQ, are thought to explain part of the interaction between obesity, insulin resistance, type 2 diabetes (T2DM) and coronary artery disease (CAD). Here, we illustrate the role that adiponectin and ADIPOQ variants might play in the modulation of CAD, especially in the occurrence of hyperglycemia. Recent evidence suggests that total and high molecular weight (HMW) adiponectin levels are apparent markers of better cardiovascular prognosis in patients with low risk of CAD. However, in subjects with established or high risk of CAD, these levels are associated with poorer prognosis. We also provide recent evidences relating to the genetic control of total and HMW adiponectin levels, especially evidence regarding ADIPOQ. Accumulated data suggest that both adiponectin levels and polymorphisms in the ADIPOQ gene are linked to the risk of CAD in patients with hyperglycemia, and that these associations seem to be independent from each other, even if adiponectin levels are partly dependent on ADIPOQ. Arq Bras Endocrinol Metab. 2011;55(7):446-54 Keywords Total adiponectin; HMW adiponectin; ADIPOQ; polymorphisms; coronary artery disease; type 2 diabetes mellitus SUMáRio Os níveis plasmáticos de adiponectina e o gene codante desta proteína, ADIPOQ, parecem explicar parte da interação de doenças como obesidade, resistência à insulina, diabetes melito tipo 2 (DM2) e doença arterial coronariana (DAC). Apresentamos as evidências do papel tanto dos níveis de adiponectina quanto das variantes no ADIPOQ na modulação da DAC, sobretudo na presença de hiperglicemia. Estudos recentes sugerem que níveis de adiponectina total e de alto peso molecular (HMW) são marcadores de bom prognóstico DAC, sobretudo em pacientes de baixo risco cardiovascular, enquanto nos pacientes de alto risco ou com doença já estabelecida podem se associar com pior prognóstico. Apresentamos também as evidências em relação ao possível controle genético dos níveis circulantes de adiponectina, tanto total quanto da isoforma de alto peso molecular, sobretudo em relação ao ADIPOQ. A análise global dos dados sugere que tanto os níveis circulantes de adiponectina quanto polimorfismos no gene ADIPOQ estão implicados na evolução de DAC em pacientes com hiperglicemia e que essas associações podem existir de forma independente. Arq Bras Endocrinol Metab. 2011;55(7):446-54 Descritores Adiponectina total; adiponectina de alto peso molecular; ADIPOQ; polimorfismo; doença arterial coronariana; diabetes melito tipo 2 review

Association of classical risk factors and coronary artery disease in type 2 diabetic patients submitted to coronary angiography

“…Accumulating evidence suggests that higher plasma adiponectin is a surrogate biological marker for better cardiovascular prognosis, mainly in patients with low risk of CVD [12]. In subjects with high risk of CVD, as seen in our present study group, or in those with established CAD, however, higher total adiponectin level seems to be associated with poorer prognosis [33].…”

“…A possible explanation is that higher or neutral levels of adiponectin in the CAD group may be a physiological response to limit endothelial damage in the very early stage of the atherogenic process. In more advanced disease, however, compensatory processes, including an increase in adiponectin levels, are often superseded [12]. …”

“…Since there are patients with T2DM that do not develop CAD, other factors besides hyperglycemia probably modulate CAD risk. Besides classical risk factors, interest has also been drawn to other measurable factors that could improve CAD risk assessment for T2DM patients, such as adiponectin and high-sensitivity C-Reactive Protein (hsCRP), among others [12]. The importance of identifying risk factors unique to CAD patients with T2DM is to control specific threats and outline goals, allowing more targeted preventive measures, thus reducing their morbidity and mortality.…”

Is There Any Association Between Adiponectin Gene Polymorphisms and Cardiovascular Disease?

“…6 Except for the differences in the population characteristics, statistical adjustments, and analytical methods used in these studies, the higher levels of adiponectin in patients with high risk of CVD may be a compensatory physiological response to prevent endothelial damage. 6,7 Adiponectin Gene Polymorphisms and Risk for DM and MetS…”

“…2,6 On the other hand, some studies in patients with high CVD risk or established CAD have reported higher total adiponectin levels to be associated with higher mortality. 6 Except for the differences in the population characteristics, statistical adjustments, and analytical methods used in these studies, the higher levels of adiponectin in patients with high risk of CVD may be a compensatory physiological response to prevent endothelial damage. 6,7 Adiponectin Gene Polymorphisms and Risk for DM and MetS…”