Bispebjerg University Hospital, Copenhagen, Denmark Gentofte University Hospital, Copenhagen, Denmark
Bispebjerg University Hospital, Copenhagen, Denmark Gentofte University Hospital, Copenhagen, Denmark University of Copenhagen, Copenhagen, Denmark.
Eur J Prev Cardiol. 2015 Mar;22(3):276-83. doi: 10.1177/2047487313514894. Epub 2013 Nov 21.
Adiponectin is viewed as an insulin-sensitizing hormone with anti-inflammatory effects. In accordance, plasma adiponectin is decreased in metabolic disorders including type 2 diabetes mellitus (T2DM). However, in spite of the apparently beneficially effects, recent data from large prospective studies have consistently linked high adiponectin levels with increased cardiovascular (CV) disease and mortality, thus questioning the positive view on adiponectin. Accordingly, we investigated the relationship between adiponectin, incident T2DM and subsequently CV events.
We prospectively followed 5349 randomly selected men and women from the community, without T2DM or CV disease. Plasma adiponectin was measured at study entry. Median follow-up time was 8.5 years (IQR 8.0-9.1 years). During follow up, 136 participants developed T2DM. Following their diagnosis, 36 of the 136 participants experienced a CV event (myocardial infarction, ischaemic stroke, or CV death).
Participants with increasing adiponectin had reduced risk of developing T2DM (p < 0.001). After adjustment for confounding risk factors (including age, gender, body mass index, physical activity, alcohol consumption, blood glucose, HbA1c, blood pressure, lipids, high-sensitivity C-reactive protein, estimated glomerular filtration rate, and plasma N-terminal pro-brain natriuretic peptide, competing risk Cox-regression analysis identified adiponectin as an independent predictor of T2DM: hazard ratio (HR) for each doubling of adiponectin 0.55 (95% CI 0.41-0.74; p < 0.001). After development of T2DM, the risk of a CV event more than doubled. Increasing adiponectin (adjusted for the confounding risk factors mentioned) was associated with reduced risk of CV events: HR 0.34 (95% CI 0.16-0.72; p = 0.005) for each doubling in plasma adiponectin.
In conclusion, increasing plasma adiponectin is associated with decreased risk of T2DM and subsequently reduced risk of CV events.
脂联素被视为一种具有抗炎作用的胰岛素增敏激素。相应地，在包括 2 型糖尿病（T2DM）在内的代谢紊乱中，血浆脂联素会降低。然而，尽管有明显的有益作用，但最近来自大型前瞻性研究的数据一致表明，高脂联素水平与心血管（CV）疾病和死亡率增加有关，从而对脂联素的积极观点提出了质疑。因此，我们研究了脂联素与 2 型糖尿病的发生以及随后的 CV 事件之间的关系。
我们前瞻性地随访了来自社区的 5349 名随机选择的男性和女性，他们没有 2 型糖尿病或 CV 疾病。在研究开始时测量了血浆脂联素。中位随访时间为 8.5 年（IQR 8.0-9.1 年）。在随访期间，有 136 名参与者患上了 2 型糖尿病。在他们被诊断出患有 2 型糖尿病后，有 36 名参与者经历了 CV 事件（心肌梗死、缺血性中风或 CV 死亡）。
随着脂联素的增加，参与者患 2 型糖尿病的风险降低（p<0.001）。在调整了混杂的危险因素（包括年龄、性别、体重指数、体力活动、饮酒量、血糖、HbA1c、血压、血脂、高敏 C 反应蛋白、估计肾小球滤过率和血浆 N 末端脑钠肽前体）后，脂联素是 2 型糖尿病的独立预测因子：脂联素每增加一倍的风险比（HR）为 0.55（95%CI 0.41-0.74；p<0.001）。在发生 2 型糖尿病后，CV 事件的风险增加了一倍以上。随着脂联素的增加（调整了上述混杂的危险因素），CV 事件的风险降低：血浆脂联素每增加一倍，HR 为 0.34（95%CI 0.16-0.72；p=0.005）。
总之，血浆脂联素的增加与 2 型糖尿病风险的降低以及随后 CV 事件风险的降低有关。
