Association of serum adiponectin with risk for cardiovascular events in patients with peripheral arterial disease

Objects: Adiponectin exerts anti-atherogenic and anti-inflammatory properties and may be important as a biomarker for cardiovascular disease (CVD). We examined whether serum adiponectin was linked with future cardiovascular events or all-cause death in patients with peripheral arterial disease (PAD). Methods: The study prospectively included 468 patients (58% male) with symptomatic PAD. Serum total adiponectin was determined by an in-house immunoassay. We used Cox regression, adjusted for age, gender, BMI, systemic hypertension, smoking status, diabetes mellitus, previous myocardial infarction (MI), ankle-brachial index (ABI), symptoms of leg ischemia, total cholesterol, and use of beta-blockers (BAB) and angiotensin-converting enzyme (ACE) inhibitors to assess possible relationship between serum adiponectin and time to first non-fatal cardiovascular event, and all-cause death. Results: During the median follow-up of 3.5 years, 215 new cases of non-fatal cardiovascular events and 97 all-cause deaths were detected. Adjusted Cox-regression analysis showed that a 1 mg/l increase in serum adiponectin was associated with a decrease in the risk of non-fatal cardiovascular events to 0.68, (95% CI 0.47-0.99) in men, but not in women (HR 0.96 95% CI 0.55-1.70). The relative risk of adverse non-fatal cardiovascular events was 77% higher in male patients within the lower adiponectin tertile, when compared with those in the higher tertile (95% CI 1.05-2.97). Moreover, serum adiponectin was the only significant independent predictor of non-fatal cardiovascular events for men with severe PAD (HR = 0.37, 95% CI, 0.16-0.89; p = 0.026), whereas previous MI (p = 0.92) and ABI (p = 0.08) failed to reach statistical significance in the multivariable model. We did not obtain any significant associations between serum adiponectin and all-cause mortality. Multivariable model revealed that age and previous MI were independently associated with risk for all-cause death. Conclusions: Lower levels of serum adiponectin were significantly associated with an increased risk for future non-fatal cardiovascular events in men with symptomatic PAD, but not in women. (C) 2009 Elsevier Ireland Ltd. All rights reserved.