Relationship of Serum Adiponectin Level to Adverse Cardiovascular Events in Patients Who Undergo Percutaneous Coronary Intervention

Prognostic value of adiponectin level in patients with coronary artery disease: a systematic review and meta-analysis

Background

Conflicting results on the prognostic value of blood adiponectin level in patients with coronary artery disease (CAD) have been reported. This meta-analysis aimed to investigate the prognostic value of elevated adiponectin level in CAD patients.

Methods

A comprehensive literature search was conducted in PubMed and Embase databases up to May 10, 2019. Studies evaluating the association between adiponectin level and major adverse cardiovascular events (death, stroke, acute coronary syndrome or coronary revascularisation), cardiovascular mortality, and all-cause mortality in CAD patients were included. Pooled multivariable adjusted risk ratios (RR) and 95% confidence intervals (CI) was calculated for the highest vs the lowest category of adiponectin level.

Results

Twelve studies including 10,974 CAD patients were included. Elevated adiponectin level was independently associated with higher risk of cardiovascular (RR 1.93; 95% CI 1.55–2.42; p < 0.001) and all-cause mortality (RR 1.96; 95% CI 1.64–2.34; p < 0.001) in CAD patients. However, CAD patients with higher adiponectin level did not significantly increase major cardiovascular events risk (RR 1.12; 95% CI 0.86–1.45; p = 0.407) after adjustment for potential confounders.

Conclusions

This meta-analysis indicates that elevated adiponectin level is an independent predictor of cardiovascular and all-cause mortality in CAD patients. Measurement of blood adiponectin level has potential to identify CAD patients who have high risk of death.

Adiponectin and insulin resistance are related to restenosis and overall new PCI in subjects with normal glucose tolerance: the prospective AIRE Study

Background

In patients with Normal Glucose Tolerance (NGT) some causes of ischemic heart disease (IHD) were not completely investigated. The role both of metabolic milieu and adipokines in IHD progression was not fully investigated. Our aim was to assess the link between adipokines plasma levels, insulin resistance (IR) and IHD in NGT patients undergoing Percutaneous Coronary Intervention (PCI).

Methods

AIRE is a single-center prospective longitudinal observational study investigating the IHD outcome of NGT subjects who underwent coronary revascularization by PCI in a third level cardiology center at A.O. dei Colli Hospital, University of Campania “Luigi Vanvitelli”. Six hundred seventy-nine subjects hospitalized in 2015 for coronary arteriography not suffering from Acute Coronary Syndrome (ACS) in the previous 4 weeks, as well as from all conditions could affect glycemic plasma levels and IR status, were assessed for eligibility. Fifty-four patients with neither history of diabetes nor Altered Fasting Glucose (AFG)/Impaired Fasting Glucose (IGT) after Oral Glucose Tolerance Test (OGTT) were finally enrolled. Primary endpoint was the assessment of the relationship of adipokines and HOMA-IR with the occurrence of restenosis in NGT subjects. As secondary endpoint we assessed the association of the same adipokines and IR with overall ACS events after PCI in NGT subjects.

Results

The 54 NGT patients enrolled were mainly males (85%), with a median age of 60 years [IQR 58–63 years]. Only 4 patients (7.4%) experimented restenosis. Median follow-up was equal to 29.5 months [IQR 14.7–34 months]. Adiponectin levels were independently associated to restenosis (OR 0.206; 95% CI 0.053–0.796; p = 0.000). Instead HOMA-IR and adiponectin appeared independently associated both to de novo IHD (OR 9.6*10¹³; 95% CI 3.026–3.08*10²⁷; p = 0.042 and OR 0.206; 95% CI 0.053–0.796; p = 0.000, respectively) and overall new PCI (OR 1.5*10¹¹; 95% CI 2.593–8.68*10²¹; p = 0.042 and OR 0.206; 95% CI 0.053–0.796; p = 0.000, respectively). Moreover, we fixed a potential cut-off for adiponectin for risk of restenosis (≤ 8.5 µg/mL) and overall new PCI (≤ 9.5 µg/mL).

Conclusion

IR and cytokines play a role in progression of any stage of IHD also in NGT subjects. Our results in this setting of patients, though the relatively small sample size, represent a novelty. Future studies on larger populations are needed to analyze more in depth adipokines and insulin resistance role on IHD progression in non-diabetic people.

Electronic supplementary material

The online version of this article (10.1186/s12933-019-0826-0) contains supplementary material, which is available to authorized users.

Elective percutaneous coronary intervention leads to significant changes in serum resistin, leptin, and adiponectin levels regardless of periprocedural myocardial injury: an observational study

Objective:

Bioactive roles of adipokines in coronary atherosclerosis and acute coronary syndromes have been demonstrated previously. However, there is a lack of data regarding the relationship between serum adipokines and periprocedural myocardial injury (PMI) following elective percutaneous coronary intervention (PCI). Therefore, we aimed to investigate the association between serum adipokines and PMI related to elective PCI.

Methods:

In total, 153 consecutive patients (aged 60.6±8.2 years, 98 men) with stable angina pectoris undergoing elective PCI were enrolled in this observational cross-sectional study. Serum resistin, leptin, adiponectin, and high-sensitive Troponin T (hscTnT) levels were measured immediately before PCI and after 12-h PCI. The no-injury, PMI, and type 4a myocardial infarction (type 4a MI) groups were defined as groups consisting patients with post-procedural hscTnT concentrations <14 ng/L, between 14–70 ng/L, and >70 ng/L, respectively.

Results:

Serum hscTnT, resistin, and leptin concentrations significantly (p<0.001) increased while serum adiponectin levels decreased (p<0.001) after 12-h elective PCI. However, no correlation was found between post-procedural hscTnT concentrations and resistin, leptin, and adiponectin levels. The no-injury group consisted of 65 patients (42.4%), whereas PMI and type 4a MI were observed in 70 (45.8%) and 18 (11.8%) patients, respectively. The average pre-procedural and post-procedural resistin, leptin, and adiponectin levels did not show any significant difference in the no-injury, PMI, and type 4a MI groups.

Conclusion:

There is no correlation between serum adipokine levels and post-procedural troponin elevations reflecting PMI or type 4a MI. However, serum resistin and leptin levels increase, whereas adiponectin levels decrease significantly after elective PCI.

Omega-3 fatty acids' effect on leptin and adiponectin concentrations in patients with spinal cord injury: A double-blinded randomized clinical trial

CONTEXT

Omega-3 fatty acids have been recently proposed to induce neural improvement in patients with spinal cord injury (SCI) while affecting some hormones including leptin and adiponectin.

OBJECTIVES

We tried to evaluate the effect of omega-3 fatty acids on circulatory concentrations of leptin and adiponectin among these patients.

DESIGN

This study is a double-blinded randomized clinical trial with intervention duration of 14 months.

SETTING

A tertiary rehabilitation center.

PARTICIPANTS

Total of 104 patients with SCI who did not meet our exclusion criteria entered the study. Those with history of diabetes, cancer, endocrinology disease, acute infection, and use of special medications were excluded. Patients were divided randomly into the treatment and control group by using permuted balanced block randomization.

INTERVENTION

The treatment group received two MorDHA® capsules per day (each capsule contain 465 mg of docosahexaenoic acid (DHA) and 63 mg of eicosapentaenoic acid (EPA)) for 14 months while the control group received placebo capsules with similar color, shape, and taste.

MAIN OUTCOMES MEASURES

Leptin and adiponectin concentrations in plasma were measured at the beginning of trial and then after 6 and 14 months.

RESULTS

Fourteen months of treatment with DHA and EPA did not influence concentrations of leptin but adiponectin level was significantly decreased (P: 0.03). Weight was positively correlated with leptin level at stage 0 of trial (P: 0.008, r=0.41) while this association was attenuated through stages of trial after intervention.

CONCLUSION

Our data show that omega-3 fatty acids may not affect plasma concentrations of leptin but adiponectin level is decreased in patients with SCI. Moreover, this intervention influences the linear relationship between weight and leptin after 14 months administration of DHA and EPA.

Significance of nitric oxide synthases: Lessons from triple nitric oxide synthases null mice

Nitric oxide (NO) is synthesized by three distinct NO synthases (neuronal, inducible, and endothelial NOSs), all of which are expressed in almost all tissues and organs in humans. The regulatory roles of NOSs in vivo have been investigated in pharmacological studies with non-selective NOS inhibitors. However, the specificity of the inhibitors continues to be an issue of debate, and the authentic significance of NOSs is still poorly understood. To address this issue, we generated mice in which all three NOS genes are completely disrupted. The triple NOSs null mice exhibited cardiovascular abnormalities, including hypertension, arteriosclerosis, myocardial infarction, cardiac hypertrophy, diastolic heart failure, and reduced EDHF responses, with a shorter survival. The triple NOSs null mice also displayed metabolic abnormalities, including metabolic syndrome and high-fat diet-induced severe dyslipidemia. Furthermore, the triple NOSs null mice showed renal abnormalities (nephrogenic diabetes insipidus and pathological renal remodeling), lung abnormalities (accelerated pulmonary fibrosis), and bone abnormalities (increased bone mineral density and bone turnover). These results provide evidence that NOSs play pivotal roles in the pathogenesis of a wide variety of disorders. This review summarizes the latest knowledge on the significance of NOSs in vivo, based on lessons learned from experiments with our triple mutant model.

A new, microalgal DHA- and EPA-containing oil lowers triacylglycerols in adults with mild-to-moderate hypertriglyceridemia

In this double-blind, parallel trial, 93 healthy adults with hypertriglyceridemia (triacylglycerols [TAG] 150-499 mg/dL) were randomized to receive either a nutritional oil derived from marine algae (DHA-O; 2.4 g/day docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA] in a 2.7:1 ratio), fish oil (FO; 2.0 g/day DHA and EPA in a 0.7:1 ratio), or a corn oil/soy oil control as 4-1g softgel capsules/day with meals for 14 weeks; and were instructed to maintain their habitual diet. Percent changes from baseline for DHA-O, FO, and control, respectively, were TAG (-18.9, -22.9, 3.5; p<0.001 DHA-O and FO vs. control), low-density lipoprotein cholesterol (4.6, 6.8, -0.6; p<0.05 DHA-O and FO vs. control), and high-density lipoprotein cholesterol (4.3, 6.9, 0.6; p<0.05 FO vs. control). This study demonstrated that ingestion of microalgal DHA-O providing 2.4 g/day DHA+EPA lowered TAG levels to a degree that was not different from that of a standard fish oil product, and that was significantly more than for a corn oil/soy oil control.

Adiponectin is associated with increased mortality in patients with already established cardiovascular disease: a systematic review and meta-analysis

BACKGROUND

The overall quantitative estimate on the possible association of adiponectin concentrations with mortality in patients with cardiovascular diseases (CVD) has not been reported.

METHODS

We performed a systematic review and meta-analysis of prospective studies to evaluate the overall quantitative estimates on the adiponectin levels for risk of mortality in patients with CVD. MEDLINE, EMBASE, CINAHL, and the Cochrane Library (up to Mar 22, 2014) were used to search for studies evaluating the effect of adiponectin levels on mortality in patients with CVD. Random-effect models were selected to estimate overall effect estimates.

RESULTS

Data from 14063 CVD patients enrolled in 15 prospective cohort and 1 nested case control studies were collated. The meta-analyses showed strong positive association of adiponectin with all-cause (n=14 studies, overall pooled effect estimate=1.45 [95% CI, 1.17-1.79]) and cardiovascular (n=11 studies, overall pooled effect estimate=1.69 [1.35-2.10]) mortality, for the highest tertile of adiponectin levels versus the lowest tertile. Subgroup analyses show study characteristics (including effect estimate, mean age, study location, sample sizes, gender, durations of follow-up, types of primary event, and acute or chronic CVD) did not substantially influence these positive associations.

CONCLUSIONS

Our results showed that increased baseline plasma adiponectin levels are significantly associated with elevated risk of all-cause and cardiovascular mortality in subjects with CVD. These positive associations may have been amplified by adjustment for potential intermediates or residual confounding, and their basis requires further investigation.

Omega-3 polyunsaturated fatty acids increase plasma adiponectin to leptin ratio in stable coronary artery disease

BACKGROUND

Growing evidence suggests a cardioprotective role of omega-3 polyunsaturated fatty acids (PUFA). However, the exact mechanisms underlying the effects of omega-3 PUFA in humans have not yet been fully clarified.

PURPOSE

We sought to evaluate omega-3 PUFA-mediated effects on adipokines in patients with stable coronary artery disease (CAD) undergoing elective percutaneous coronary intervention (PCI).

METHODS

We conducted a prospective, double-blind, placebo-controlled, randomized study, in which adiponectin, leptin and resistin were determined at baseline, 3-5 days and 30 days during administration of omega-3 PUFA 1 g/day (n=20) or placebo (n=28).

RESULTS

As compared to controls administration of omega-3 PUFA resulted in increase of adiponectin by 13.4% (P<0.0001), reduction of leptin by 22% (P<0.0001) and increase of adiponectin to leptin (A/L) ratio by 45.5% (P<0.0001) at 30 days, but not at 3-5 days. Compared with placebo adiponectin was 12.7% higher (P=0.0042), leptin was 16.7% lower (P<0.0001) and A/L ratio was 33.3% higher (P<0.0001) in the omega-3 PUFA group at 30 days. Resistin decreased similarly in both groups after 1 month, without intergroup differences (P=0.32). The multivariate model showed that the independent predictors of changes in adiponectin at 1 month (P<0.001) were: omega-3 PUFA treatment, baseline platelet count, total cholesterol and those in leptin (P<0.0001) were: omega-3 PUFA treatment and waist circumference. Independent predictors of A/L ratio changes (P<0.0001) were: assigned treatment, current smoking and hyperlipidemia.

CONCLUSIONS

In high risk stable coronary patients after PCI omega-3 PUFA supplementation improves adipokine profile in circulating blood. This might be a novel, favourable mechanism of omega-3 PUFA action.

Risk assessment of post-infarction heart failure. Systematic review on the role of emerging biomarkers

The prognostic significance of cardiospecific troponins and natriuretic peptides in patients with myocardial ischemia is well established, and their measurement is now endorsed by the most important guidelines and recommendations for diagnosis and management of heart failure (HF). Additional biomarkers have also been investigated to support clinical judgment and diagnostic imaging in the stratification of risk of cardiac dysfunction in patients with myocardial infarction (MI). We have performed a systematic analysis of the current scientific literature regarding the most important biomarkers of HF, selecting all prospective studies with adequate sample size (i.e. >100 patients) that have assessed, during the early phase of myocardial ischemia, the prognostic value of emergent biomarkers for new-onset HF or deterioration of cardiac function in patients with MI. This analysis has provided some good evidence suggesting that, in most cases, the use of diagnostic biomarkers of cardiac dysfunction does not translate into efficient risk prediction of HF. However, some notable exceptions were found, including biomarkers of cardiac fibrosis (especially galectin-3), growth differentiation factor-15 (GDF-15), osteoprotegerin, C-reactive protein (CRP), and red blood cell distribution width (RDW). Nevertheless, future studies with well-defined characteristics including the use of larger sample sizes, standardized end points, and replication populations, along with benchmark analyses against other consolidated biomarkers (i.e. cardiospecific troponins and natriuretic peptides), should be planned. Such evaluations will help to establish whether an integrated approach including biomarkers of different pathogenetic pathways - for example, apoptosis, stress of cardiomyocytes, cardiac fibrosis, inflammation, and extra-cardiac involvement - may be cost effective for identifying patients at increased risk of developing HF, and who, therefore, may benefit from a tailored therapeutic strategy.

More than a simple storage organ: adipose tissue as a source of adipokines involved in cardiovascular disease

Overweight and obesity in many countries have developed into a serious health problem by themselves and by their impact on other pathologies such as insulin resistance, type 2 diabetes, hypertension, heart disease and cancer. The modulation of these diseases by adipose tissue-derived biomolecules, so-called adipokines, could be the key to differentiate between metabolically healthy and unhealthy obesity. This review will discuss the pathophysiological role of selected adipokines, primarily focusing on cardiovascular diseases. Furthermore, we will highlight possible therapeutic approaches, which target these biomolecules.

Association of adiponectin with future cardiovascular events in patients after acute myocardial infarction

AIM

There is uncertainty about the association between circulating concentrations of adiponectin and coronary heart disease risk, particularly in patients after acute myocardial infarction (AMI). The goal of this study was to determine whether plasma adiponectin levels could predict future cardiovascular events in patients after AMI, and to elucidate the role of adiponectin in cardioprotection.

METHODS

A total of 102 patients with AMI were enrolled. Plasma adiponectin levels were examined from blood samples collected 18 months after AMI. All subjects were followed-up for 43+/-12 months. The primary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including rehospitalization due to unstable angina, nonfatal MI, revascularization with percutaneous coronary intervention or coronary artery bypass grafting, ischemic stroke, and cardiovascular death.

RESULTS

A total of 30 MACE occurred, including one case of cardiovascular death, five cases of nonfatal MI, and nine cases of ischemic stroke. Patients with MACE had lower plasma adiponectin levels (p=0.013). In addition, adiponectin was positively associated with changes in left ventricular ejection fraction (p=0.005). All patients were divided into a high-adiponectin group (>or=6.46 microg/mL) and a low-adiponectin group (<6.46 microg/mL). The incidence of MACE was significantly reduced in the high-adiponectin group (p=0.021). In multivariate Cox regression analysis that included adiponectin, classical risk factors, and medications, adiponectin was an independent predictor of MACE in patients after AMI (HR, 0.821; 95% CI, 0.691 to 0.974; p=0.024).

CONCLUSIONS

The results indicate a potential association between plasma adiponectin levels and future cardiovascular events in patients after AMI. Moreover, plasma adiponectin concentrations appear to play a pivotal role in atherothrombosis and cardioprotection.

Nitric oxide synthases in the pathogenesis of cardiovascular disease: lessons from genetically modified mice

Nitric oxide (NO) is produced in almost all tissues and organs, exerting a variety of biological actions under both physiological and pathological conditions. NO is synthesized by three distinct NO synthase (NOS) isoforms (neuronal, inducible, and endothelial NOS), all of which are expressed in the human cardiovascular system. Although the regulatory roles of NOSs in cardiovascular diseases have been described in pharmacological studies with selective and non-selective NOS inhibitors, the specificity of the NOS inhibitors continues to be an issue of debate. To overcome this issue, genetically engineered animals have been used. All types of NOS gene-deficient animals, including singly, doubly, and triply NOS-deficient mice, and various types of NOS gene-transgenic (TG) animals, including conditional and non-conditional TG mice bearing endothelium-specific or cardiomyocyte-specific overexpression of each NOS gene, have thus been developed. The roles of individual NOS isoforms as well as the entire NOS system in the cardiovascular system have been extensively investigated in those mice, providing pivotal insights into an understanding of the pathophysiology of NOSs in human cardiovascular diseases. Based on studies with the murine NOS genetic models, this review briefly summarizes the latest knowledge of NOSs and cardiovascular diseases.

Effect of adiponectin overexpression on stability of preexisting plaques by inducing prolyl-4-hydroxylase expression

BACKGROUND

Although adiponectin has been implicated as an antiinflammatory factor in atherosclerotic lesion development, little is known about its role in advanced atherosclerotic plaque. This study assessed the effect and mechanism of adiponectin on the expression of prolyl 4-hydroxylase (P4H) alpha1 and its role in the stability of preexisting plaque.

METHODS AND RESULTS

Atherosclerotic lesions in the carotid arteries of apolipoprotein E-deficient mice were induced by the placement of a perivascular collar. Six weeks after surgery, 120 mice were divided into phosphate-buffered saline (PBS) (n=40), empty adenovirus (Ad.Empty) (n=40) and adiponectin adenovirus (Ad.Adipo) groups (n=40). The number of vulnerable lesions were lower with Ad.Adipo than with Ad.Empty transfection. Mean cap thickness, cap area, cap-to-core ratio and intimal collagen content were all greater with Ad.Adipo than with Ad.Empty transfection; however, the groups did not differ in plaque area or intima-media thickness. Plasma adiponectin level positively correlated with intimal collagen content. Adiponectin transfection conferred enhanced expression of P4H, with no changes in the PBS and Ad.Empty groups.

CONCLUSIONS

Adiponectin increases collagen production by inducing the expression of P4H, which may play a major role in the development of the thick fibrous cap of advanced atherosclerotic plaque.

Interaction of ADIPOQ genetic polymorphism with blood pressure and plasma cholesterol level on the risk of coronary artery disease

BACKGROUND

The protective effect of +45T >G polymorphism in the adiponectin gene (ADIPOQ) on coronary artery disease (CAD) has been demonstrated in European populations, so this study investigated the effect of +45T >G polymorphism on the risk of CAD and its interactions with other metabolic risk factors in a Chinese population.

METHODS AND RESULTS

The +45T >G polymorphism (rs2241766) of ADIPOQ was genotyped in 600 patients with angiographically diagnosed CAD and in 718 controls. The G allele at the +45T >G polymorphism was associated with a lower risk of CAD (odds ratio (OR), 0.76; 95% confidence interval (CI), 0.64-0.89; P=0.001). The protective effect of the G allele at +45T >G polymorphism was magnified at blood pressure <140/90 mmHg (OR, 0.65; 95%CI, 0.51-0.82; P=0.0004), but disappeared at blood pressure >or=140/90 mmHg (OR, 0.98; 95%CI, 0.76-1.28; P=0.93), indicating an interaction between +45T >G polymorphism and blood pressure on CAD risk (P=0.02 for interaction). A similar interaction was also observed between plasma cholesterol level and the +45T >G polymorphism.

CONCLUSIONS

An association of ADIPOQ genetic polymorphism with CAD risk is modified by traditional risk factors, such as blood pressure and plasma cholesterol level.

Plasma adiponectin levels are associated with insulin sensitivity in stroke survivors

OBJECTIVE

Adiponectin is an anti-inflammatory and insulin-sensitizing adipokine produced by adipose tissue. The purpose of this study was to determine the relationships between adiponectin and glucose metabolism in stroke survivors and to compare adiponectin levels between patients with stroke and nonstroke control subjects similar in age, sex, and body mass index.

METHODS

In all, 52 stroke survivors (35 men, 17 women) and 33 nonstroke control subjects (22 men, 11 women) had plasma adiponectin levels measured by RIA, an oral glucose tolerance test, and a peak oxygen consumption-graded treadmill test. Insulin resistance (IR) and insulin sensitivity were assessed using the homeostasis model assessment for IR (HOMA-IR) and insulin sensitivity index (ISI(M)).

RESULTS

Adiponectin levels were positively associated with age (r = 0.32, P < .05) and negatively associated with glucose homeostasis (fasting glucose: r = -0.42; insulin: r = -0.36; Glucose at (120 min): r = -0.39; HOMA-IR: r = -0.45; and ISI(M): r = 0.44, all P < .01) in stroke survivors. Adiponectin levels were significantly different among normal glucose-tolerant, impaired glucose-tolerant, and diabetic patients with stroke (11.1 +/- 0.99 v 9.56 +/- 0.99 v 5.75 +/- 1.55 ng/mL, P < .05). Adiponectin levels were 62% higher in patients with stroke than control subjects (9.29 +/- 0.62 v 5.80 +/- 0.40 ng/mL, P < .001) despite greater fasting insulin levels (81%) and 120-minute insulin (70%) in stroke survivors than control subjects (P < .05). HOMA-IR was 78% higher and ISI(M) was 81% lower in stroke survivors than control subjects (P < .05).

CONCLUSIONS

Plasma adiponectin levels are associated with age and insulin sensitivity but not adiposity in stroke survivors. The paradoxical finding that the more IR stroke survivors had higher adiponectin levels than more insulin-sensitive control subjects suggests that perhaps anti-inflammatory cytokines increase to counter an inflamed and IR state in stroke survivors.

Nitric oxide synthases and cardiovascular diseases: insights from genetically modified mice

Nitric oxide (NO) is produced in almost all tissues and organs, exerting a variety of biological actions under both physiological and pathological conditions. NO is synthesized by 3 distinct NO synthase (NOS) isoforms (neuronal, inducible, and endothelial NOS), all of which are expressed in the human cardiovascular system. The regulatory roles of NOSs in cardiovascular diseases have been described in pharmacological studies with selective and non-selective NOS inhibitors. However, the specificity of the NOS inhibitors continues to be an issue of debate. To overcome this issue, genetically engineered animals have been used. All types of NOS gene-deficient (knockout: KO) animals, including singly, doubly, and triply NOS-KO mice, and various types of NOS gene-transgenic (TG) animals, including conditional and non-conditional TG mice bearing endothelium-specific or cardiomyocyte-specific overexpression of each NOS gene, have thus far been developed. The roles of individual NOS isoforms, as well as the entire NOS system, in the cardiovascular system have been extensively investigated in those mice, and the results provide pivotal insights into the pathophysiology of NOSs in human cardiovascular diseases. Based on studies with murine NOS genetic models, this review summarizes the latest knowledge of NOSs and cardiovascular diseases.

Association of adiponectin with mortality in older adults: the Health, Aging, and Body Composition Study

AIMS/HYPOTHESIS

Despite inverse associations with insulin resistance and adiposity, adiponectin has been associated with both increased and decreased risk of cardiovascular disease. We examined whether adiponectin is associated with total and cardiovascular mortality in older adults with well-characterised body composition.

METHODS

We analysed data from 3,075 well-functioning adults aged 69-79 years at baseline. Mortality data were obtained over 6.6 +/- 1.6 years. We used Cox proportional hazards models adjusting for covariates in stages to examine the association between adiponectin and total and cardiovascular mortality.

RESULTS

There were 679 deaths, 36% of which were from cardiovascular disease. Unadjusted levels of adiponectin were not associated with total or cardiovascular mortality. However, after adjusting for sex and race, adiponectin was associated with an increased risk of both total mortality (hazard ratio 1.26, 95% CI 1.15-1.37, per SD) and cardiovascular mortality (hazard ratio 1.35, 95% CI 1.17-1.56, per SD). Further adjustment for study site, smoking, hypertension, diabetes, prevalent heart disease, HDL-cholesterol, LDL-cholesterol, renal function, fasting insulin, triacylglycerol, BMI, visceral fat, thigh intermuscular fat and thigh muscle area did not attenuate this association. This association between adiponectin and increased mortality risk did not vary by sex, race, body composition, diabetes, prevalent cardiovascular disease, smoking or weight loss.

CONCLUSIONS/INTERPRETATION

Higher levels of adiponectin were associated with increased risks of total and cardiovascular mortality in this study of older persons.

Effect of anti-TNF treatment on body composition and serum adiponectin levels of women with rheumatoid arthritis

The aim of this study was to investigate the effect of anti-tumor necrosis factor alpha (anti-TNF) treatment on body composition and serum adiponectin levels of women with rheumatoid arthritis (RA). Nineteen women with RA starting anti-TNF treatment were included in the study. Disease activity, body composition, lumbar spine bone mineral density (BMD) and serum adiponectin concentrations were measured at baseline and after 1 year of follow-up. No important changes on body composition and lumbar spine BMD were observed, while the serum levels of adiponectin levels increased after 1 year of anti-TNF treatment (p = 0.02). Anti-TNF treatment in women with RA does not have any significant effect on body composition; however, it is associated with increase in adiponectin levels which may ameliorate the systemic inflammatory response state associated with RA.

Vascular risk factors in South Asians

South Asians originate from the Indian sub-continent (India, Pakistan, Bangladesh, Sri Lanka and Nepal) and represent one fifth of the world's population. Several studies suggested that South Asians have an increased risk of developing coronary heart disease (CHD) when compared with European populations. We review the role of traditional and emerging risk factors in the increased CHD risk in South Asians. The high prevalence of insulin resistance and type 2 diabetes mellitus in South Asians may be a major cause for their elevated vascular risk. However, other established and emerging risk factors are also overrepresented in South Asians. Large-scale prospective studies could determine the relative contribution of established and emerging vascular risk factors in South Asians. There is an urgent need for trials in South Asians that will evaluate clinical outcomes following treatment of these risk factors.