Adiponectin is independently associated with NT-proBNP: The Multi-Ethnic Study of Atherosclerosis

Menopausal age, adipokines, and heart failure incidence in postmenopausal women of the Multi-Ethnic Study of Atherosclerosis

OBJECTIVE

The mechanisms through which menopausal age influences heart failure (HF) development are controversial. Adiposity increases after menopause and could affect HF risk by influencing serum adipokine secretion. We investigated the associations of early menopause, and serum adipokines with incident HF in postmenopausal women.

METHODS

We included 746 postmenopausal women from the Multi-Ethnic Study of Atherosclerosis who reported their menopausal age and had data on adipokines and incident HF at the end of follow-up. Multivariable Cox proportional hazards models were used for analysis.

RESULTS

The mean age was 65.1 years. Over a median follow-up period of 17.8 years, 45 HF events occurred. After adjusting for waist circumference, other cardiovascular disease risk factors and myocardial infarction, the hazard ratios (95% confidence intervals) of incident HF attributable to early menopause were 4.50 (1.41-14.3), 4.64 (1.46-14.7), and 5.16 (1.59-16.7) in models that additionally included adiponectin, leptin, and resistin, respectively. In adjusted analyses, adiponectin was independently associated with incident HF 2.20 (1.35-3.57), while leptin and resistin were not. The interaction terms of early menopause with adiponectin, leptin, and resistin for incident HF were not significant ( Pint = 0.08-0.82).

CONCLUSIONS

Early menopause was significantly associated with incident HF. This association did not differ by serum adipokine levels. Only adiponectin was independently associated with incident HF in postmenopausal women when waist circumference, body mass index, and waist-hip ratio were used as the adiposity metric.

Adipokines in the Crosstalk between Adipose Tissues and Other Organs: Implications in Cardiometabolic Diseases

Adipose tissue was previously regarded as a dormant organ for lipid storage until the identification of adiponectin and leptin in the early 1990s. This revelation unveiled the dynamic endocrine function of adipose tissue, which has expanded further. Adipose tissue has emerged in recent decades as a multifunctional organ that plays a significant role in energy metabolism and homeostasis. Currently, it is evident that adipose tissue primarily performs its function by secreting a diverse array of signaling molecules known as adipokines. Apart from their pivotal function in energy expenditure and metabolism regulation, these adipokines exert significant influence over a multitude of biological processes, including but not limited to inflammation, thermoregulation, immune response, vascular function, and insulin sensitivity. Adipokines are pivotal in regulating numerous biological processes within adipose tissue and facilitating communication between adipose tissue and various organs, including the brain, gut, pancreas, endothelial cells, liver, muscle, and more. Dysregulated adipokines have been implicated in several metabolic diseases, like obesity and diabetes, as well as cardiovascular diseases. In this article, we attempted to describe the significance of adipokines in developing metabolic and cardiovascular diseases and highlight their role in the crosstalk between adipose tissues and other tissues and organs.

Associations between muscle quality and N-terminal pro-B-type natriuretic peptide (NT-proBNP): The multi-ethnic study of atherosclerosis

INTRODUCTION

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is widely used in clinical settings to identify cardiac stress, diagnose, and manage heart failure (HF). We explored the associations between NT-proBNP and both muscle area and density.

METHODS

A cross-sectional analysis including 1,489 participants from the MESA. Plasma NT-proBNP concentrations and inflammatory biomarkers and health history questionnaires were analyzed. Computed tomography quantified abdominal body composition. Separate multivariable linear regression models were used to assess the associations between both muscle (MA) area and density (MD) and NT-proBNP.

RESULTS

In models adjusted for sociodemographic characteristics, risk factors for cardiovascular disease, anthropometric variables, and subcutaneous and visceral adiposity, NT-proBNP was inversely associated with total abdominal and psoas MAs. Adjustment for inflammatory markers and MD attenuated these associations to the null. Stabilization MA and NT-proBNP were not significantly associated. Analyses per quartiles of MA confirmed lack of a consistent association between stabilization and total abdominal MAs and NT-proBNP. While the third and fourth quartiles of psoas MA were inversely associated with NT-proBNP, adding inflammation biomarkers and MD to the model attenuated the association to the null. Conversely, after full adjustment, NT-proBNP was inversely and significantly associated with total abdominal, stabilization and psoas MDs. For psoas MD, but not the other muscle density variables, the addition of MA to the model attenuated the association to the null. The quartiles of MD were consistently inversely associated with NT-proBNP, where higher MDs showed larger estimates of the association compared to the lowest quartiles, for all muscle groups investigated.

CONCLUSION

Muscle density is inversely associated with NT-proBNP, while muscle area is not after adjustment for inflammation and muscle density.

The Interplay between Adipose Tissue Properties and Levels of NT-proBNP in People with HIV

Objective

We aimed to assess the association between low N-terminal pro-brain natriuretic peptide (NT-proBNP) and body mass index (BMI), adipose tissue distribution, adiponectin, and HIV-specific risk factors among people with HIV (PWH).

Methods

We included 811 PWH with measurement of height, weight and waist circumference, blood samples analyzed for NT-proBNP, and visceral-(VAT) and subcutaneous (SAT) adipose tissue areas measured from CT-scans. Low concentrations of NT-proBNP were defined as concentrations below the limit of quantification (5.9 pmol/L). Associations were explored with multivariable logistic regression analyses adjusted for relevant confounders.

Results

We identified 471 (58%) individuals with low concentrations of NT-proBNP. Increasing BMI was associated with higher odds of low NT-proBNP (adjusted OR (aOR) 1.06 (95% CI: 1.01-1.11) per 1 kg/m2). Central obesity and large areas of VAT were associated with higher odds of low NT-proBNP (aOR 1.66 (1.16-2.36) and aOR 1.69 (1.09-2.62), respectively). Higher adiponectin was associated with lower odds of low NT-proBNP (aOR 0.86 (0.79-0.95) per 10% increase). No associations were found between low NT-proBNP and HIV-specific risk factors.

Conclusions

In PWH, low NT-proBNP is associated with an adverse adipose tissue profile with high BMI, central obesity, accumulation of VAT, and low adiponectin.

Serum adiponectin concentrations as a risk factor for cardiovascular complications in type 1 diabetes

AIM

By analyzing data from DCCT/EDIC study, we investigated the associations of serum adiponectin concentrations with macrovascular complications and cardiovascular events in T1D.

MATERIALS AND METHODS

Adiponectin concentrations were measured in EDIC year 8. The participants (n = 1040) were divided into four groups by quartiles of adiponectin concentrations. The association of macrovascular complications and cardiovascular events were analyzed by using multivariable regression and Cox proportional hazards models.

RESULTS

High adiponectin concentrations were associated with decreased risk of peripheral artery disease represented by ankle brachial index (ORs (95% CI): 0.22 (0.07-0.72), 0.48 (0.18-1.25), and 0.38 (0.14-0.99) in fourth, third, and second quartiles compared with first quartile), with reduced carotid intima-media thickness, and with increased LVEDV index. Moreover, high adiponectin concentrations were also associated with increased risk of any cardiovascular events (HRs (95% CI): 2.59 (1.10-6.06), 2.03 (0.90-4.59), and 1.22 (0.52-2.85)) and major atherosclerotic cardiovascular events (HRs (95% CI): 11.37 (2.04-63.43), 5.68 (1.04-31.07), and 3.76 (0.65-21.77) in fourth, third, and second quartiles compared with first quartile), however, after adjustments with LVEDV index, these associations were diminished.

CONCLUSIONS

Adiponectin may protect carotid atherosclerosis and peripheral artery disease in T1D. It may be associated with increased cardiovascular events, depending on cardiac structural changes.

Mendelian randomization study of the relation between adiponectin and heart function, unravelling the paradox

High adiponectin concentrations are generally regarded as beneficial with regard to cardiometabolic health, but have been paradoxically associated with increased cardiovascular disease risk, specifically heart failure, in individuals at high cardiovascular risk. We aimed to investigate the association between adiponectin and heart function parameters, and inversely, we estimated the effect of genetically-determined heart function and NT-proBNP as the main marker of heart failure on adiponectin using Mendelian randomisation. Observational analyses between adiponectin and measures of heart function, i.e. E/A ratio, left, and right ventricular ejection fraction, were performed in participants of the Netherlands Epidemiology of Obesity (NEO) study, assessed by MRI of the heart (n = 1,138). Two-sample Mendelian randomisation analyses were conducted to estimate the effect of NT-proBNP and heart function on adiponectin concentrations using publicly-available summary statistics (ADIPOGen; the PLATO trial). The mean (standard deviation) age was 56 (6) years and mean body mass index was 26 (4) kg/m². Per five μg/mL higher adiponectin, the E/A ratio was -0.05 (95 % CI: -0.10, -0.01) lower, left ventricle ejection fraction was -0.5 % (95 % CI: -1.1, 0.1) lower, and right ventricle ejection fraction was 0.5 % (95 % CI: -0.1, 1.2) higher. Genetically-determined NT-proBNP was causally related to adiponectin concentrations in ADIPOGen: per doubling of genetically-determined NT-proBNP, adiponectin concentrations were 11.4 % (95 % CI: 1.7, 21.6) higher. With causal MR methods we showed that NT-proBNP affects adiponectin concentrations, while adiponectin is not associated with heart function parameters. Therefore, reverse causation may explain the adiponectin paradox observed in previous studies.

Adiponectin and Asthma: Knowns, Unknowns and Controversies

Adiponectin is an adipokine associated with the healthy obese phenotype. Adiponectin increases insulin sensitivity and has cardio and vascular protection actions. Studies related to adiponectin, a modulator of the innate and acquired immunity response, have suggested a role of this molecule in asthma. Studies based on various asthma animal models and on the key cells involved in the allergic response have provided important insights about this relation. Some of them indicated protection and others reversed the balance towards negative effects. Many of them described the cellular pathways activated by adiponectin, which are potentially beneficial for asthma prevention or for reduction in the risk of exacerbations. However, conclusive proofs about their efficiency still need to be provided. In this article, we will, briefly, present the general actions of adiponectin and the epidemiological studies supporting the relation with asthma. The main focus of the current review is on the mechanisms of adiponectin and the impact on the pathobiology of asthma. From this perspective, we will provide arguments for and against the positive influence of this molecule in asthma, also indicating the controversies and sketching out the potential directions of research to complete the picture.

Adiponectin and cardiometabolic trait and mortality: where do we go?

Adiponectin is an adipocyte-derived cytokine known for its cardioprotective effects in preclinical studies. Early epidemiologic studies replicated these findings and drew great interest. Subsequent large-scale prospective cohorts, however, showed that adiponectin levels seemed not to relate to incident coronary artery disease (CAD). Even more surprisingly, a paradoxical increase of all-cause and cardiovascular (CV) mortality with increased adiponectin levels was reported. The adiponectin-mortality paradox has been explained by some groups asserting that adiponectin secretion is promoted by elevated natriuretic peptides (NP). Other groups have proposed that adiponectin is elevated due to adiponectin resistance in subjects with metabolic syndrome or heart failure (HF). However, there is no unifying theory that can clearly explain this paradox. In patients with HF with reduced ejection fraction (HFrEF), stretched cardiomyocytes secrete NPs, which further promote release of adiponectin from adipose tissue, leading to adiponectin resistance. On the other hand, adiponectin biology may differ in patients with heart failure with preserved ejection fraction (HFpEF), which constitutes 50% of all of HF. Most HFpEF patients are obese, which exerts inflammation and myocardial stiffness, that is likely to prevent myocardial stretch and subsequent NP release. This segment of the patient population may display a different adiponectin biology from its HFrEF counterpart. Dissecting the adiponectin-mortality relation in terms of different HF subtypes may help to comprehensively understand this paradox. Mendelian Randomization (MR) analyses claimed that adiponectin levels are not causally related to CAD or metabolic syndrome. Results from MR studies, however, should be interpreted with great caution because the underlying history of CAD or CHF were not taken into account in these analyses, an issue that may substantially confound the results. Here, we discuss many aspects of adiponectin; cardiometabolic traits, therapeutic interventions, and the ongoing debate about the adiponectin paradox, which were recently described in basic, epidemiologic, and clinical studies.

Association between Serum Adiponectin and Atrial Fibrillation: A Case-Control Study Stratified by Age and Gender

Background

Circulating adiponectin has been suggested to be associated with atrial fibrillation (AF). However, whether the association differs by age and gender remains unknown. We performed a case-control study to evaluate the above association.

Methods

AF patients who underwent 24-hour long-range 12-channel electrocardiogram examination at our center were included in this study, and people with normal sinus rhythm (NSR) were included as controls. All participants underwent echocardiography and heart rate variability tests. Biochemical parameters and adiponectin levels were also evaluated. Receiver operating characteristic (ROC) analyses were used to determine the predictive efficacy of adiponectin for AF, and multivariate logistic regression analysis was performed to evaluate the potential independent predictors of AF.

Results

Overall, 84 patients with AF and 84 people with NSR were included. Serum adiponectin was significantly higher in AF patients compared to that in controls (P < 0.001). ROC analysis showed that higher serum adiponectin (>6.098 μg/mL) had predictive efficacy for AF, with an area under the curve of 0.660 (95% confidence interval [CI]: 577–0.742). The results of multivariate logistic regression analysis showed that higher adiponectin was an independent predictor of AF in the overall participants (odds ratio [OR] 1.224, 95% CI 1.018–1.471, P=0.032). Subgroup analysis showed that higher adiponectin was independently associated with AF in women (OR 1.893, 95% CI 1.160–3.089, P=0.011) and in patients aged < 65 years (OR 1.453, 95% CI 1.023–2.064, P=0.037), but not in men or those aged ≥ 65 years.

Conclusions

Higher serum adiponectin level was independently associated with higher odds for AF in women and in participants <65 years old, but not in men or those aged ≥65 years.

Associations of adiponectin and leptin with brain natriuretic peptide in African Americans: the Jackson Heart Study

Brain natriuretic peptide (BNP) is elevated in decompensated systolic and diastolic heart failure. The plasma levels of adipokines, such as adiponectin and leptin, may provide evidence for mechanistic differences in BNP concentrations. African-American-specific associations are limited in the literature. The objective of this study was to evaluate the associations of adiponectin and leptin with BNP among African Americans.

METHODS

Linear and logistic regressions were used to test the associations between adiponectin, leptin, and plasma BNP in 3738 participants of the Jackson Heart Study (JHS), a single-site prospective cohort study of African Americans in Jackson, Mississippi.

RESULTS

A direct relationship of adiponectin was observed in multiple multivariate-adjusted linear models: in men (β = 0.41-0.47), and in women (β = 0.32-0.38). Those in the highest quartile of adiponectin expression were twice as likely to have elevated BNP levels after adjustment [odds ratio 2.66 (95% confidence interval, 1.66-4.34)]. An inverse relationship of leptin with BNP was observed (β = -0.15) but attenuated after adjustment for aldosterone, renin, and adiponectin.

CONCLUSIONS

Different linear associations of adiponectin and leptin with BNP were observed. Odds of elevated adiponectin were observed with elevated BNP in multivariate-adjusted models. This paradoxical relationship of adiponectin and plasma BNP is possibly explained through adiponectin resistance.

Nutrients restriction upregulates adiponectin in epicardial or subcutaneous adipose tissue: impact in de novo heart failure patients

Background: Hyperadiponectinemia is an indicator of worse outcomes in advanced heart failure (HF), its role in de novo HF is less clear. Objective: Because this protein is a hormone with starvation properties, we wanted to know its association with nutritional state and its regulator factors in de novo HF. Methods: Adiponectin circulating levels were determined by ELISA at discharge in patients admitted for de novo HF (n=74). Nutritional status was determined by CONUT score. Univariate and multivariate Cox regression analyses were employed to calculate the estimated hazard ratio (HR) with 95% confidence interval (CI) for death or all-cause readmission. Stromal vascular cells (SVC) of EAT and subcutaneous adipose tissue (SAT) from patients (n=5) underwent heart surgery were induced to adipogenesis for 18 days. Then, cells were cultured with complete or starved medium for 8 hours. At the end, adiponectin expression levels were analysed by real time polymerase chain reaction. Results: Patients were grouped regarding nutritional status. There was a strong association between high adiponectin levels and failing nutritional status. Those patients with worse nutritional state had the highest adiponectin and proBNP levels at discharge (p<0.01). Both proteins were slightly correlated (p<0.05). However, only high adiponectin levels were independently associated with death or all-cause readmission. Nutrients starvation upregulated adiponectin expression levels in adipogenesis-induced SVC from EAT or SAT. Conclusions: Worse nutritional state in de novo HF patients is associated with higher adiponectin plasma levels. Their levels were upregulated in adipose cells after being nutrients-starved. These results may help us to understand the adiponectin paradox in HF.

Circulating B-type natriuretic peptide in women with and without recent gestational diabetes: The impact of current glucose intolerance

CONTEXT

Circulating B-type natriuretic peptide, as measured by the N-terminal fragment of its prohormone (NT-proBNP), is inversely associated with incident type 2 diabetes (T2DM) but positively related to future cardiovascular disease (CVD). Recognizing that gestational diabetes (GDM) identifies women at future risk for both T2DM and CVD, we sought to determine whether gestational glucose tolerance relates to NT-proBNP in the years after delivery.

DESIGN/PATIENTS/MEASUREMENTS

Three hundred and forty women underwent a glucose challenge test (GCT) and an oral glucose tolerance test (OGTT) in pregnancy, yielding 4 gestational glucose tolerance groups: GDM (n = 105); gestational impaired glucose tolerance (n = 59); abnormal GCT with a normal OGTT (n = 98); and normal GCT with normal OGTT (n = 75). At 3-year postpartum, they underwent cardiometabolic characterization (including measurement of estimated glomerular filtration rate (eGFR), adiponectin and NT-proBNP) and repeated the OGTT, revealing 69 women with glucose intolerance (prediabetes/diabetes).

RESULTS

At 3-year postpartum, serum NT-proBNP did not differ between the 4 original gestational glucose tolerance groups (P = .44), but instead progressively decreased across current glucose tolerance strata, from normal to prediabetes to diabetes (P = .006). Indeed, on logistic regression analysis, NT-proBNP emerged as a negative predictor of prediabetes/diabetes (OR = 0.903, 95% CI 0.825-0.988, P = .026). On multiple linear regression analyses of NT-proBNP, the significant association with current glucose intolerance was ultimately attenuated in a fully adjusted model, revealing two independent determinants of NT-proBNP: eGFR (t = -2.71, P = .007) and adiponectin (t = 2.44, P = .015).

CONCLUSION

Serum NT-proBNP relates to current glucose intolerance, rather than preceding gestational dysglycaemia. Thus, the diabetic (rather than vascular) risk implications of NT-proBNP predominate in young women.