Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Arterioscler Thromb Vasc Biol. 2013 May;33(5):1092-7. doi: 10.1161/ATVBAHA.112.301089. Epub 2013 Feb 28.
Lower concentrations of adiponectin have been linked to subsequent risk of coronary heart disease in healthy individuals. Whether similar relationships exist for the development of systemic atherosclerosis, such as peripheral artery disease (PAD), is uncertain. We investigated the association between total adiponectin and risk of lower extremity PAD.
We performed a prospective, nested case-control study among 18,225 male participants of the Health Professionals Follow-up Study who were free of diagnosed cardiovascular disease at the time of blood draw (1993-1995). During 14 years of follow-up, 143 men developed PAD. Using risk set sampling, controls were selected in a 3:1 ratio and matched on age, smoking status, fasting status, and date of blood draw (n=429). Median (interquartile range) adiponectin concentrations at baseline were lower among cases compared with controls (4.1 [3.2-5.5] versus 5.4 [3.8-7.5] µg/mL; P<0.001). A log-linear inverse association was evident over the full spectrum of adiponectin concentrations with PAD risk after controlling for baseline cardiovascular risk factors using restricted spline conditional logistic regression. Adiponectin was associated with a 42% lower risk of PAD per SD increase in natural log-transformed adiponectin (relative risk, 0.58; 95% confidence interval, 0.45-0.74) after adjustment for cardiovascular risk factors. The relative risk was attenuated (relative risk, 0.68; 95% confidence interval, 0.51-0.92) after further accounting for high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, C-reactive protein, and cystatin C. Additional adjustment for hemoglobin A(1c), triglycerides, and γ-glutamyltransferase had little impact on this association (relative risk, 0.68; 95% confidence interval, 0.50-0.92).
Total adiponectin is inversely associated with risk of symptomatic lower extremity PAD in men.
在健康个体中，较低浓度的脂联素与随后发生冠心病的风险相关。脂联素与全身性动脉粥样硬化（如外周动脉疾病，PAD）的发展是否存在类似的关系尚不确定。我们研究了总脂联素与下肢 PAD 风险之间的关系。
我们在 1993 年至 1995 年期间进行了一项前瞻性、嵌套病例对照研究，研究对象为参加健康专业人员随访研究的 18225 名男性，在采血时无心血管疾病诊断。在 14 年的随访期间，143 名男性发生了 PAD。采用风险集抽样，按年龄、吸烟状况、禁食状态和采血日期以 3:1 的比例选择对照（n=429）。与对照组相比，病例组在基线时的脂联素浓度中位数（四分位距）较低（4.1[3.2-5.5]与 5.4[3.8-7.5]µg/mL；P<0.001）。在用受限样条条件逻辑回归控制基线心血管危险因素后，在整个脂联素浓度范围内观察到脂联素与 PAD 风险呈对数线性负相关。与心血管危险因素调整后，脂联素每增加一个自然对数转换的 SD，PAD 风险降低 42%（相对风险，0.58；95%置信区间，0.45-0.74）。进一步考虑高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、C 反应蛋白和胱抑素 C 后，相对风险减弱（相对风险，0.68；95%置信区间，0.51-0.92）。对血红蛋白 A1c、甘油三酯和γ-谷氨酰转移酶进行额外调整对这种关联影响不大（相对风险，0.68；95%置信区间，0.50-0.92）。
总脂联素与男性有症状性下肢 PAD 风险呈负相关。
