Adiponectin, diabetes and ischemic heart failure: a challenging relationship

Abstract

BackgroundSeveral peptides, named adipokines, are produced by the adipose tissue. Among those, adiponectin (AD) is the most abundant. AD promotes peripheral insulin sensitivity, inhibits liver gluconeogenesis and displays anti-atherogenic and anti-inflammatory properties. Lower levels of AD are related to a higher risk of myocardial infarction and a worse prognosis in patients with coronary artery disease. However, despite a favorable clinical profile, AD increases in relation to worsening heart failure (HF); in this context, higher adiponectinemia is reliably related to poor prognosis. There is still little knowledge about how certain metabolic conditions, such as diabetes mellitus, modulate the relationship between AD and HF.We evaluated the level of adiponectin in patients with ischemic HF, with and without type 2 diabetes, to elucidate whether the metabolic syndrome was able to influence the relationship between AD and HF.ResultsWe demonstrated that AD rises in patients with advanced HF, but to a lesser extent in diabetics than in non-diabetics. Diabetic patients with reduced systolic performance orchestrated a slower rise of AD which began only in face of overt HF. The different behavior of AD in the presence of diabetes was not entirely explained by differences in body mass index. In addition, NT-proBNP, the second strongest predictor of AD, did not differ significantly between diabetic and non-diabetic patients. These data indicate that some other mechanisms are involved in the regulation of AD in patients with type 2 diabetes and coronary artery disease.ConclusionsAD rises across chronic heart failure stages but this phenomenon is less evident in type 2 diabetic patients. In the presence of diabetes, the progressive increase of AD in relation to the severity of LV dysfunction is hampered and becomes evident only in overt HF.

Urinary adiponectin concentration is positively associated with micro- and macro-vascular complications

“…Recently, a few studies have appeared reporting that circulating adiponectin did not show a cardioprotective effect in animal models [28]. In humans, serum adiponectin concentrations rise across chronic heart failure stages, although this finding is less evident in type 2 diabetic patients according to the study by Baldasseroni et al [29]. In our results, we did not find evidence of a protective role for serum adiponectin against vascular damage, in accord with these reports.…”

Adiponectin resistance in skeletal muscle: pathophysiological implications in chronic heart failure

“…Low plasma concentrations of adiponectin precede the onset of type‐2 diabetes . Heart failure patients with diabetes have lower adiponectin levels compared with patients without diabetes . This also applies to heart failure patients with or without the metabolic syndrome .…”

“…A marked elevation in plasma adiponectin levels was found in patients with overt heart failure compared with patients with CAD and no heart failure . In addition, circulating adiponectin levels were higher in patients with CAD and heart failure as opposed to asymptomatic heart failure patients with normal or reduced left ventricular ejection fraction (LVEF) . Likewise, Wannamethee and colleagues investigated the association of adiponectin with all‐cause and cardiovascular disease (CVD) mortality in a prospective study of 4046 men aged 60–79 years, participating in the British Regional Heart Study.…”

Circulating adiponectin and cardiovascular mortality in patients with type 2 diabetes mellitus: evidence of sexual dimorphism

“…Thus, it is surprising that, high adiponectin levels predict increased risk of heart failure (HF) [9,10] as well as CV mortality in the general population and in selected clinical settings [11–21]. A similar unexpected paradoxical association with the risk of CV mortality has been also described in patients with type 1 diabetes [22] and in kidney transplant recipients [23].…”