TY - JOUR
T1 - Serum adiponectin concentration is a positive predictor of all-cause and cardiovascular mortality in type 1 diabetes
AU - Forsblom, C.
AU - Thomas, M. C.
AU - Moran, J.
AU - Saraheimo, M.
AU - Thorn, L.
AU - Wadén, J.
AU - Gordin, D.
AU - Frystyk, J.
AU - Flyvbjerg, A.
AU - Groop, P. H.
AU - on behalf of the FinnDiane Study Group
PY - 2011/1/1
Y1 - 2011/1/1
N2 - Background. Adiponectin is widely regarded as an anti-atherogenic, antioxidant and anti-inflammatory molecule. However, adiponectin concentration is paradoxically increased in individuals with type 1 diabetes, in whom it is positively associated with adverse clinical outcomes. Objective. To explore the association between serum adiponectin concentration and mortality outcomes in adults with type 1 diabetes. Design. Multicentre prospective cohort study. Setting. Primary and tertiary care. Subjects. Finnish adults with type 1 diabetes (n= 2034). Main outcome measures. All-cause and cardiovascular mortality. Independent predictors of mortality were determined using the Cox and the Fine and Gray competing risks proportional hazards models. Results. During a median of 11years of follow-up, there were 173 deaths (8.5%, 1.0 per hundred person-years). Adiponectin was linearly associated with all-cause mortality [Cox model: hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.01-1.03, P<0.001] and cardiovascular mortality (Fine and Gray model: HR 1.02, 95% CI 1.00-1.04, P=0.035); patients with the highest adiponectin concentrations had the shortest survival. The mortality risk associated with adiponectin was independent of glycaemic and lipid control, pre-existing cardiovascular disease, markers of inflammation and the presence and severity of kidney disease. Conclusions. Although adiponectin is generally considered to be a protective molecule, increased concentrations of adiponectin in type 1 diabetes are independently associated with all-cause and cardiovascular mortality. Moreover, the fact that this association was observed for the first time in patients with normal urinary albumin levels, who have few comorbidities, suggests that adiponectin is specifically linked with vascular damage in type 1 diabetes.
AB - Background. Adiponectin is widely regarded as an anti-atherogenic, antioxidant and anti-inflammatory molecule. However, adiponectin concentration is paradoxically increased in individuals with type 1 diabetes, in whom it is positively associated with adverse clinical outcomes. Objective. To explore the association between serum adiponectin concentration and mortality outcomes in adults with type 1 diabetes. Design. Multicentre prospective cohort study. Setting. Primary and tertiary care. Subjects. Finnish adults with type 1 diabetes (n= 2034). Main outcome measures. All-cause and cardiovascular mortality. Independent predictors of mortality were determined using the Cox and the Fine and Gray competing risks proportional hazards models. Results. During a median of 11years of follow-up, there were 173 deaths (8.5%, 1.0 per hundred person-years). Adiponectin was linearly associated with all-cause mortality [Cox model: hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.01-1.03, P<0.001] and cardiovascular mortality (Fine and Gray model: HR 1.02, 95% CI 1.00-1.04, P=0.035); patients with the highest adiponectin concentrations had the shortest survival. The mortality risk associated with adiponectin was independent of glycaemic and lipid control, pre-existing cardiovascular disease, markers of inflammation and the presence and severity of kidney disease. Conclusions. Although adiponectin is generally considered to be a protective molecule, increased concentrations of adiponectin in type 1 diabetes are independently associated with all-cause and cardiovascular mortality. Moreover, the fact that this association was observed for the first time in patients with normal urinary albumin levels, who have few comorbidities, suggests that adiponectin is specifically linked with vascular damage in type 1 diabetes.
KW - Adiponectin
KW - Death
KW - Diabetes
KW - Mortality
KW - Type 1 diabetes
UR - http://www.scopus.com/inward/record.url?scp=80052965327&partnerID=8YFLogxK
U2 - 10.1111/j.1365-2796.2011.02406.x
DO - 10.1111/j.1365-2796.2011.02406.x
M3 - Article
AN - SCOPUS:80052965327
SN - 0954-6820
VL - 270
SP - 346
EP - 355
JO - Journal of Internal Medicine
JF - Journal of Internal Medicine
IS - 4
ER -