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Low and high adiponectin levels linked to death in type 2 diabetics

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Both low and high levels of adiponectin are associated with an increased risk of death in patients with type 2 diabetes, according to study findings presented Tuesday at the 20th World Diabetes Congress in Montreal.

By contrast, adiponectin levels are not independent predictors of prevalent cardiovascular disease (CVD) or death from CVD.

“To my knowledge, this is the first study of the relationship of serum total adiponectin to prevalent CVD (and to) CVD and all cause mortality in a representative, community-based cohort of people with type 2 diabetes,” lead author Dr. Wendy Davis, from the University of Western Australia, Fremantle, told Reuters Health.

Dr. Davis cited the U-shaped relationship between adiponectin levels and all-cause mortality as being the biggest finding in the study and also the most surprising, noting that while low levels of adiponectin have been tied to insulin resistance and a poor cardiovascular risk profile, high levels have not.

The findings stem from an analysis of baseline data (1993 to 1996) for 1158 patients with type 2 diabetes who participated in the Fremantle Diabetes Study. The data from this study was linked with data from the Western Australia mortality register (January 1993 to June 2007).

Roughly half of the subjects were female and the average age at baseline was 63.9 years. The subjects had a formal diagnosis of diabetes for a median of 4.0 years. About half of the subjects had a history of CVD and a higher prevalence was seen in males.

On multivariate analysis, the total adiponectin level was not an independent predictor of prevalent CVD or CVD death in either sex.

Relative to the second adiponectin quintile, the fifth quintile was associated with a 1.64-fold increased risk of all-cause mortality in men. In women, the high quintiles were also tied to elevated risks (HR 2.09 for fourth and 1.96 for fifth quintile), but so was the first quintile with a 1.86-fold increased risk.

The take-home message, Dr. Davis said, is that “higher total adiponectin levels are not protective against all-cause death, but augmenting levels in patients with type 2 diabetes with very low levels may be beneficial.” Further study, she added, is needed to verify this.