Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
J Atheroscler Thromb. 2010 Mar 31;17(3):295-303. doi: 10.5551/jat.3533. Epub 2010 Feb 26.
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.
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.
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).
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.
关于脂联素的循环浓度与冠心病风险之间的关系存在不确定性，特别是在急性心肌梗死（AMI）后患者中。本研究的目的是确定 AMI 后患者的血浆脂联素水平是否可以预测未来的心血管事件，并阐明脂联素在心脏保护中的作用。
共纳入 102 例 AMI 患者。从 AMI 后 18 个月采集的血液样本中检测血浆脂联素水平。所有患者均随访 43+/-12 个月。主要终点是主要不良心血管事件（MACE）的综合发生，包括因不稳定型心绞痛、非致命性心肌梗死、经皮冠状动脉介入或冠状动脉旁路移植术血运重建、缺血性卒中和心血管死亡而再次住院。
共发生 30 例 MACE，包括 1 例心血管死亡、5 例非致命性心肌梗死和 9 例缺血性卒中。MACE 患者的血浆脂联素水平较低（p=0.013）。此外，脂联素与左心室射血分数的变化呈正相关（p=0.005）。所有患者均分为高脂联素组（>或=6.46μg/mL）和低脂联素组（<6.46μg/mL）。高脂联素组 MACE 发生率显著降低（p=0.021）。在包括脂联素、经典危险因素和药物在内的多变量 Cox 回归分析中，脂联素是 AMI 后患者 MACE 的独立预测因子（HR，0.821；95%CI，0.691 至 0.974；p=0.024）。
结果表明，AMI 后患者的血浆脂联素水平与未来心血管事件之间存在潜在关联。此外，血浆脂联素浓度似乎在动脉粥样血栓形成和心脏保护中发挥关键作用。
