Adiponectin and Risk of Coronary Heart Disease in Older Men and Women

　　Context： Despite established insulin-sensitizing and antiatherogenic preclinical effects， epidemiological investigations of adiponectin have yielded conflicting findings， and its relationship with coronary heart disease （CHD） remains uncertain.

　　Objective： Our objective was to investigate the relationship between adiponectin and CHD in older adults.

　　Design， Setting， and Participants： This was a case-control study （n = 1386） nested within the population-based Cardiovascular Health Study from 1992 to 2001. Controls were frequency-matched to cases by age， sex， race， subclinical cardiovascular disease， and center.

　　Main Outcome Measures： Incident CHD was defined as angina pectoris， percutaneous or surgical revascularization， nonfatal myocardial infarction （MI）， or CHD death. A more restrictive CHD endpoint was limited to nonfatal MI and CHD death.

　　Results： Adiponectin exhibited significant negative correlations with baseline adiposity， insulin resistance， dyslipidemia， inflammatory markers， and leptin. After controlling for matching factors， adjustment for waist to hip ratio， hypertension， smoking， alcohol， low-density lipoprotein cholesterol， creatinine， and leptin revealed a modestly increased risk of incident CHD with adiponectin concentrations at the upper end [odds ratio = 1.37 （quintile 5 vs. 1 to 4）， 95% confidence interval 1.02 to 1.84]. This association was stronger when the outcome was limited to nonfatal MI and fatal CHD （odds ratio = 1.69， 95% confidence interval 1.23 to 2.32）. The findings were not influenced by additional adjustment for weight change， health status， or cystatin C， nor were they abolished by adjustment for potential mediators.

　　Conclusions： This study shows an association between adiponectin and increased risk of first-ever CHD in older adults. Further research is needed to elucidate the basis for the concurrent beneficial and detrimental aspects of this relationship， and under what circumstances one or the other may predominate.