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

Aarhus University Hospital, Aarhus, Central Jutland, Denmark
Circulation (Impact Factor: 14.43). 10/2005; 112(12):1756-62. DOI: 10.1161/CIRCULATIONAHA.104.530972
Source: PubMed


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.
In 195 CHF patients (age 69.3+/-10.2 years, BMI 27.3+/-5.2 kg/m2, left ventricular ejection fraction 30+/-8.9%, mean+/-SD), plasma adiponectin and N-terminal pro brain natriuretic peptide (NT-proBNP) were measured at baseline. Adiponectin was positively associated with NT-proBNP (beta=0.47, P<0.001), and both biomarkers were negatively associated with BMI (beta=-0.43, P<0.001 for adiponectin and beta=-0.38, P<0.001 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 <25%, 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 (P=0.032). BMI predicted mortality independently of clinical parameters of CHF severity (hazard ratio=0.63, P=0.012), but this association became insignificant after additional adjustment for NT-proBNP (hazard ratio=0.74, P=0.13).
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.

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    • "c o m / l o c a t e / i j c a r d explanation for the obesity paradox directly involves the functions of adipose tissue [12] [15]. Adipose tissue produces leptin which experimental studies suggest may have protective effects in HF [17] and adiponectin is decreased in obesity; lower concentrations of adiponectin have been associated with lower mortality in patients with CHD or HF [18] [19] [20]. However few population studies to date have examined the possible role of lean muscle mass, adipokines (leptin , adiponectin) and NT-proBNP in explaining the obesity paradox, although previous studies suggest that NT-proBNP and adiponectin may explain the obesity paradox in HF [18,21]. "
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    ABSTRACT: We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox. The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF). Prospective study of 4046 men aged 60-79years followed up for a mean period of 11years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF. Overweight (BMI 25-9.9kg/m(2)) and obesity (BMI≥30kg/m(2)) were associated with lower mortality risk compared to men with normal weight (BMI 18.5-24.9kg/m(2)) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p=0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p=0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p=0.60 for trend) but made minor differences to those with HF [p=0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p=0.98 for trend]. The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association.
    International journal of cardiology 11/2013; 171(1). DOI:10.1016/j.ijcard.2013.11.043 · 4.04 Impact Factor
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    • "We have previously reported of an association between BMI and NT-proBNP as well as adiponectin in CHF [6]. However, whether low BMI has an impact on plasma concentrations of these biomarkers is unknown. "
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    ABSTRACT: Low body mass index (BMI) is associated with a poor outcome in chronic heart failure (CHF). An inverse association between BMI and adiponectin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been reported. The aim of the present study was to investigate whether novel markers of neurohormonal activation, inflammation, and endothelial dysfunction are associated with BMI in CHF. In a cross-sectional study including 171 patients with CHF and a left ventricular ejection fraction (LVEF) <=45% the impact of BMI on circulating plasma concentrations of adiponectin, alpha-defensins, high sensitivity C-reactive protein (hsCRP), copeptin, mid-regional pro-adrenomedullin (MR-proADM), NT-proBNP, and mid-regional pro-A-type natriuretic peptide (MR-proANP) were evaluated. In multivariable linear regression analysis including age, sex, LVEF, New York Heart Association functional classification (NYHA), estimated glomerular filtration rate (eGFR), and diabetes, only NT-proBNP (beta = -0.32) and adiponectin (beta = -0.39) remained independently associated with BMI. MR-proANP was associated with BMI but adjusting for age attenuated the relation being no longer significant. Among biomarkers typically increased in patients with CHF only adiponectin and NT-proBNP demonstrated independent inverse associations with BMI. This indicates a direct effect of these two biomarkers enhancing the wasting process seen in CHF.
    BMC Cardiovascular Disorders 10/2013; 13(1):80. DOI:10.1186/1471-2261-13-80 · 1.88 Impact Factor
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    • "Several other studies, including the Pravastatin or Atorvastatin Evaluation and Infection Therapy‐thrombolysis in Myocardial Infarction 22 (PROVE IT‐TIMI 22) study39, have reported that high serum adiponectin levels in patients with acute coronary syndrome39 or congestive heart failure40 are associated with a higher risk of recurrent cardiovascular events. The reason for this result, which conflicts with the present result, is unclear. "
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    ABSTRACT: Aims/Introduction An inverse association between adiponectin and coronary heart disease (CHD) has been found in Caucasians, but it is uncertain whether this association can be extrapolated to the East Asian population. The present study aimed to investigate whether serum adiponectin levels can predict CHD in Japanese patients with type 2 diabetes as observed in Caucasians. Materials and Methods This longitudinal study included 504 patients with type 2 diabetes (342 men and 162 women) who were admitted to Sumitomo Hospital between July 2005 and December 2006. We used Cox proportional hazard analysis to estimate the hazard ratio (HR) of CHD associated with serum adiponectin levels at baseline. Results During a median follow up of 5.7 years (2177 person‐years), 40 participants had new CHD and 10 had recurrent CHD. After multivariate adjustment, the highest compared with the lowest quartile of serum adiponectin levels had a significantly reduced risk of CHD (hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.13–0.94; P = 0.017). The multivariate adjusted HR for the risk of CHD according to a doubling of adiponectin at baseline was 0.61 (95% CI 0.39–0.97; P = 0.037). Conclusions High serum adiponectin levels are significantly associated with a lower risk of CHD in Japanese patients with type 2 diabetes. This association is independent of other well‐known CHD risk factors.
    Journal of Diabetes Investigstion 09/2013; 4(5):475-82. DOI:10.1111/jdi.12078 · 1.83 Impact Factor
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