Department of Family Medicine, Inje University Ilsan Paik Hospital, Gyeonggi-Do, South Korea, Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA, Center for Obesity, Nutrition, and Metabolism, Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Gyeonggi-Do, South Korea, Department of Statistics, Dongguk University-Seoul, Seoul, South Korea, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea and Seoul National University College of Medicine, Seoul, South Korea.
Int J Epidemiol. 2013 Aug;42(4):1029-39. doi: 10.1093/ije/dyt087. Epub 2013 Jun 4.
Our aim was to systematically review prospective studies of the association of plasma adiponectin levels with the risk of coronary heart disease (CHD) events, cardiovascular mortality and all-cause mortality.
We searched Medline, EMBASE, the Cochrane Library and CINAHL for reports published through October 2011. Search terms included 'adiponectin' AND 'cardiovascular disease' OR 'mortality'. We included prospective studies lasting more than 1 year with plasma adiponectin levels at baseline and all-cause mortality and/or major cardiovascular morbidity and mortality as outcomes. We used a random-effects model to pool the data and conducted additional subgroup meta-analyses according to the pre-existence of CHD. Pooled relative risk (RR) was estimated by a 1-SD increase in the logarithmically transformed circulating adiponectin levels.
A total of 24 prospective studies were included in the meta-analysis. The pooled RR of adiponectin for CHD events (23 studies) was 1.03 [95% confidence interval (CI): 1.00, 1.06]. In subgroup analyses, the RR of adiponectin was 0.99 (95% CI: 0.94, 1.03) for new-onset CHD (17 studies), but there was an increased risk (RR = 1.12, 95% CI: 1.04, 1.22) for CHD recurrence (seven studies). A 10% increased risk (RR = 1.10, 95% CI: 1.04, 1.16) of all-cause mortality (six studies) and a 14% increased risk (RR = 1.14, 95% CI: 1.05, 1.23) of cardiovascular disease mortality (five studies) were observed.
No association was observed between adiponectin levels and CHD events. Our results suggest that higher circulating adiponectin levels may be associated with an increased risk of CHD recurrence and all-cause/CVD mortality.
本研究旨在系统性回顾前瞻性研究，评估血浆脂联素水平与冠心病（CHD）事件、心血管死亡率和全因死亡率风险之间的相关性。
我们检索了 Medline、EMBASE、Cochrane 图书馆和 CINAHL，检索截至 2011 年 10 月的相关文献。检索词包括“脂联素”和“心血管疾病”或“死亡率”。我们纳入了随访时间超过 1 年、基线时检测了血浆脂联素水平、且结局指标包括全因死亡率和/或主要心血管不良事件和死亡率的前瞻性研究。我们采用随机效应模型对数据进行合并，并根据是否存在 CHD 进行了亚组荟萃分析。采用 1-SD 对数转换后循环脂联素水平增加的比值比（RR）来评估合并相对风险（RR）。
共有 24 项前瞻性研究纳入荟萃分析。脂联素与 CHD 事件（23 项研究）的汇总 RR 为 1.03（95%可信区间：1.00，1.06）。在亚组分析中，脂联素与新发 CHD（17 项研究）的 RR 为 0.99（95%可信区间：0.94，1.03），但脂联素与 CHD 复发（7 项研究）的 RR 则增加（RR = 1.12，95%可信区间：1.04，1.22）。脂联素水平增加 10%（RR = 1.10，95%可信区间：1.04，1.16），全因死亡率风险增加（6 项研究），心血管疾病死亡率风险增加 14%（RR = 1.14，95%可信区间：1.05，1.23）。
脂联素水平与 CHD 事件之间无相关性。我们的结果表明，循环脂联素水平较高可能与 CHD 复发和全因/CVD 死亡率风险增加相关。
