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

Abstract

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. A diponectin, predominantly synthesized in the adipose tissue, seems to play an important role in carbohydrate and lipid metabolism and vascular biology (1). It has been found to be a major modulator of insulin action and resistance (2) and to predict the development of type 2 diabetes (3-8). Furthermore, it seems to have substantial anti-inflammatory properties (1). Adiponectin is also related to lipid metabolism, particularly higher levels of HDL cholesterol and lower levels of triglycerides (9). These data suggest that high adiponectin levels may be related to lower risk for coronary heart disease (CHD), and we demonstrated recently that adiponectin levels are associated with a lower risk for myocardial infarction among healthy men in the Health Professionals Follow-up Study (10). Lifestyle and pharmaceutical approaches that increase adiponectin levels therefore might be valuable in decreasing atherosclerotic risk, particularly in individuals with type 2 diabetes, who are at high risk. However, it remains unclear whether adiponectin levels predict CHD risk among individuals with type 2 diabetes, in whom a complex array of metabolic abnormalities most likely contributes to the elevated risk. Glycemia, blood lipids, and inflammatory markers seem to be independently associated with adiponectin levels (11), but it also remains unresolved which pathways may mediate the potential association between adiponectin and CHD risk among diabetic individuals. We therefore evaluated whether adiponectin levels predict CHD events among diabetic men and whether inflammatory markers, cholesterol levels, or HbA 1c mediates this association. RESEARCH DESIGN AND METHODSThe Health Professionals Follow-up Study is a prospective cohort study of 51,529 U.S. male health professionals (dentists, veterinarians, pharmacists, optometrists, osteopathic physicians, and podiatrists) who were aged 40 -75 years at study initiation in 1986. This cohort is followed through biennial mailed questionnaires that focus on various lifestyle factors and health outcomes. In addition, between 1993 and 1994, 18,159 study participants provided blood samples by overnight courier. Among participants who returned blood samples, 1,000 had a confirmed diagnosis of type 2 diabetes (as reported on a supplementary questionnaire sent to all men who reported a diagnosis of diabetes) at baseline or during follow-up through 1998. The present study included 745 men who di...

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