Plasma Adiponectin, Body Mass Index, and Mortality in Patients With Chronic Heart Failure

Abstract

Background-Recent studies have suggested that higher body mass index (BMI) is associated with improved prognosis in chronic heart failure (CHF). The adipocytokine adiponectin is inversely associated with BMI, and in healthy subjects, low adiponectin is a predictor of mortality. In a prospective study, we therefore evaluated the association between plasma adiponectin levels and mortality among patients with CHF. Methods and Results-In 195 CHF patients (age 69.3Ϯ10.2 years, BMI 27.3Ϯ5.2 kg/m 2 , left ventricular ejection fraction 30Ϯ8.9%, meanϮSD), plasma adiponectin and N-terminal pro brain natriuretic peptide (NT-proBNP) were measured at baseline. Adiponectin was positively associated with NT-proBNP (␤ϭ0.47, PϽ0.001), and both biomarkers were negatively associated with BMI (␤ϭϪ0.43, PϽ0.001 for adiponectin and ␤ϭϪ0.38, PϽ0.001 for NT-proBNP, respectively) During a median follow-up of 2.6 years, 46 (23.5%) of the patients died. After adjustment for clinical variables associated with CHF severity (age, systolic blood pressure, left ventricular ejection fraction Ͻ25%, duration of CHF, and creatinine clearance) and for NT-proBNP, the hazard ratio of mortality for values in the 2 upper tertiles relative to the lowest tertile of adiponectin was 3.23 (Pϭ0.032). BMI predicted mortality independently of clinical parameters of CHF severity (hazard ratioϭ0.63, Pϭ0.012), but this association became insignificant after additional adjustment for Pϭ0.13). Conclusions-A high adiponectin level was a predictor of mortality, independent of risk markers of CHF severity, presumably because of its role as a marker for wasting. BMI was also associated with mortality, but a part of this relation may be mediated by adiponectin and NT-proBNP levels.

Adiponectin protects against the development of systolic dysfunction following myocardial infarction

“…Two studies have found that high adiponectin levels are associated with increased mortality in heart failure patients [18,19], perhaps because high levels of adiponectin are indicative of systemic wasting in this population [6]. In this regard, low body mass index, which leads to elevated adiponectin levels, is associated with increased mortality following the onset of heart failure, whereas elevated body mass index, which leads to reduced adiponectin levels, increases the risk for developing heart failure [29,30].…”

“…In contrast to adiponectin's recognized cardiovascular-protective actions, recent clinical studies have shown that high adiponectin levels are a predictor of mortality in patients with advanced heart failure [18,19], while another study found that plasma adiponectin levels are not predictive of heart failure in men who were asymptomatic [20]. These epidemiological studies are difficult to interpret because systemic wasting, which is associated with high adiponectin levels, is a positive predictor of death in patients with heart failure [21].…”

Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity

“…Another possible explanation for the obesity paradox directly involves the functions of adipose tissue (11,66) . Adipose tissue produces leptin which experimental studies suggest may have protective effects in HF (71) and adiponectin is decreased in obesity; lower concentrations of adiponectin have been associated with lower mortality in patients with CHD or HF (72)(73)(74) .…”

A randomized, controlled trial of the effects of rosiglitazone on adipokines, and inflammatory and fibrinolytic markers in diabetic patients: Study design and protocol

“…Although high levels of adiponectin have been associated with reduced cardiovascular risk, recent studies have suggested that high levels of plasma adiponectin were shown to be a predictor of mortality in patients with chronic heart failure, coronary artery disease and chronic kidney disease (46)(47)(48)(49), and in a population of older men without heart failure or cardiovascular disease (50). Therefore, the relationship between adiponectin concentrations and vascular morbidity and mortality remains unclear and warrants further study.…”