espite recent improvements in survival, the 5-year mortality rate for patients with congestive heart failure (CHF) ranges between 40% and 60%. 1,2 The discovery of risk markers for CHF and their appropriate use have contributed to improved screening, prevention, diagnosis and treatment of CHF. Because the pathophysiology of CHF is complex, a variety of markers associated with different pathophysiologic conditions may be used in the management of CHF.Adiponectin is an insulin-sensitizing adipocytokine that regulates energy metabolism by increasing free fatty acid oxidation in skeletal myocytes and gluconeogenesis in the liver. [3][4][5] In addition to its beneficial effects on both lipid and glucose metabolism, adiponectin has antiinflammatory properties. 6 It reduces the endothelial expression of cell adhesion molecules and the monocyte/macrophage production of inflammatory cytokines; however, it induces antiinflammatory cytokines. 7-10 Moreover, in a mouse model of pressure overload adiponectin had antihypertrophic effects on cardiac myocytes, and its deficiency exacerbated CHF. 11,12 Myocardial expression of adiponectin receptor 1 and adiponectin receptor 2 suggest possible effects of
Circulation Journal Vol.71, May 2007adiponectin on cardiac myocytes. 13,14 Adiponectin can also inhibit growth factor-mediated fibroblast proliferation and prevent fibrosis. 15 Because these factors, namely, myocardial inflammation, hypertrophy and fibrosis, and dysregulation of myocardial lipid/glucose metabolisms can either cause or exacerbate CHF, 16,17 adiponectin may play a protective role in CHF.Increased levels of circulating adiponectin and the prognostic potential of adiponectin have been reported in Caucasian CHF patients 18,19 and very recently, an increase in the circulating adiponectin level and an association of this with the severity of CHF have been shown in Japanese CHF patients. 20 Nevertheless, it remains uncertain whether adiponectin has prognostic potential in Asians, and the difference in the circulating adiponectin levels of Caucasian and Asian patients suggests that the prognostic potential of Circ J 2007; 71: 623 -630 (Received June 26, 2006; revised manuscript received January 29, 2007; accepted February 9, 2007 Background Congestive heart failure (CHF) is associated with altered energy homeostasis and myocardial inflammation, hypertrophy, and fibrosis. Adiponectin, an insulin-sensitizing adipocytokine, may affect these pathogenic factors, and the circulating adiponectin level may serve as a biological marker of CHF. This study aimed to assess the significance of serum adiponectin as a prognostic marker for Japanese CHF patients.
Methods and ResultsThe serum adiponectin levels were compared between 54 (24 ischemic and 30 nonischemic) CHF patients with left ventricular systolic dysfunction and 55 age-and gender-matched control subjects. The CHF patients also underwent simultaneous clinical assessment and measurements for brain natriuretic peptide (BNP) and parameters of lipid or glucose metabolism. Com...