Adiponectin Profile in Asian Patients Undergoing Coronary Revascularization and Its Association With Plaque Vulnerability: IDEAS‐ADIPO Study

Abstract

Despite potent insulin-sensitizing, anti-inflammatory, and antiatherogenic effects in animal studies, the relationship between serum adiponectin level and coronary artery disease in patients remains unclear. We determined the adiponectin profile in a cohort of multiethnic Asian patients with coronary artery disease, and the association between serum adiponectin level and culprit lesion necrotic core (NC) content. Ninety-four Asian patients (BMI, 25.3 ± 3.7 kg/m 2 ) undergoing percutaneous coronary intervention were recruited. The serum adiponectin level was measured (n = 94), and the baseline virtual histology intravascular ultrasound examination was analyzed (n = 88). The median level of adiponectin was 3.7 µg/ml (interquartile range, 2.8-4.5 µg/ml). The serum adiponectin level was below 10 µg/ml in 90 patients (95.7%) and below 6 µg/ml in 80 patients (85.1%). There was a significant association between ethnicity and serum adiponectin level (P = 0.048). The median adiponectin level was highest among the Chinese, followed by the Malay and the Indians. Serum adiponectin levels were positively associated with culprit lesion NC content. A 1-µg/ml increase in log adiponectin was associated with a 3.04% (95% confidence interval: 0.33-5.44) increase in culprit lesion NC content. This association remains significant after adjusting for age, sex, ethnicity, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and procedural indication. We found a low serum level of adiponectin in Asian patients and a significant ethnic effect on serum adiponectin level. Increased serum adiponectin levels were independently associated with increased culprit lesion NC burden, suggesting a role for adiponectin in modulating coronary plaque vulnerability.

Paradoxical effects of adiponectin level on plaque vulnerability and clinical outcomes after coronary revascularization

“…Given that a high necrotic core plaque content signifies vulnerability and is predictive of subsequent cardiovascular events, our findings were in line with the hypothesis that serum adiponectin level is elevated in a counter-regulatory fashion in advanced coronary artery disease. Yet, in the same study, we found that serum adiponectin levels differed between the three ethnic groups in Singapore [6]. It was significantly lower in the Indian patients than in the Chinese and Malay patients.…”

“…In the IDEAS (Intravascular Ultrasound Diagnostic Evaluation of Atherosclerosis in Singapore)-ADIPO study, which included a cohort of multi-ethnic Asian populations undergoing coronary revascularization, we reported a positive correlation between serum adiponectin level and necrotic core coronary plaque content [6]. Given that a high necrotic core plaque content signifies vulnerability and is predictive of subsequent cardiovascular events, our findings were in line with the hypothesis that serum adiponectin level is elevated in a counter-regulatory fashion in advanced coronary artery disease.…”

“…The IDEAS-ADIPO study showed that serum adiponectin levels were positively associated with the necrotic core content of the culprit lesion in Asian patients with coronary artery disease [6]. Although a high serum adiponectin level, which is associated with a high necrotic core of the culprit lesion, is supposedly linked to a higher risk of future adverse cardiovascular events [7], we observed a paradoxical relationship in that a high serum adiponectin level was associated with a favourable prognosis.…”

“…A possible explanation is that adiponectin may be counter-regulated by excessive oxidative stress and pro-thrombotic states. There is a paucity of information on the relationship between serum adiponectin level and clinical outcomes after coronary revascularization.In the IDEAS (Intravascular Ultrasound Diagnostic Evaluation of Atherosclerosis in Singapore)-ADIPO study, which included a cohort of multi-ethnic Asian populations undergoing coronary revascularization, we reported a positive correlation between serum adiponectin level and necrotic core coronary plaque content [6]. Given that a high necrotic 1 T. Kajiya et al / International Journal of Cardiology xxx (2013) xxx-xxx ☆…”

“…In the IDEAS (Intravascular Ultrasound Diagnostic Evaluation of Atherosclerosis in Singapore)-ADIPO study, which included a cohort of multi-ethnic Asian populations undergoing coronary revascularization, we reported a positive correlation between serum adiponectin level and necrotic core coronary plaque content [6]. Given that a high necrotic 1 T. Kajiya et al / International Journal of Cardiology xxx (2013) xxx-xxx ☆…”