Serum concentrations of adiponectin and risk of type 2 diabetes mellitus and coronary heart disease in apparently healthy middle-aged men: results from the 18-year follow-up of a large cohort from southern Germany

OBJECTIVES: We sought to assess the association between serum concentrations of adiponectin and long-term risk of type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) in initially healthy middle-aged men within the same representative population in Augsburg, southern Germany.

BACKGROUND: It has been postulated that high serum concentrations of adiponectin, an emerging biomarker that is linked to insulin resistance and endothelial dysfunction, may be protective against T2DM and CHD.

METHODS: Serum concentrations of adiponectin were determined in apparently healthy middle-aged men, sampled from the general population in 1984/1985 and followed until 2002. During this period, 115 of 887 men had a newly diagnosed T2DM, and 126 of 937 men suffered from a CHD event.

RESULTS: In a Cox model, after multivariable adjustment for cardiovascular risk factors, the hazard ratio of incident T2DM, comparing extreme tertiles of the adiponectin distribution, was 0.55 (95% confidence interval [CI], 0.35 to 0.89), and for incident CHD it was 0.62 (95% CI, 0.39 to 0.98). Further adjustment for high-density lipoprotein cholesterol (HDL-C) attenuated the association, which became formally non-significant. In joint analysis, men with low adiponectin and low HDL-C values showed a 2.63 times (95% CI, 1.66 to 4.15) increased incidence of T2DM and a 1.91 times (95% CI, 1.20 to 3.04) increased incidence of CHD after multivariable adjustment in comparison with men with high HDL-C and high adiponectin.

CONCLUSIONS: For patients with low HDL-C values, additional measurement of adiponectin may be helpful to identify individuals at very high risk for T2DM and CHD.