Key result
Elevated serum levels of adiponectin (highest vs. lowest quartile) were associated with a significantly higher risk of major adverse cardiovascular and cerebrovascular events (HR 4.95) in patients with acute ischemic stroke.
Why the study?
Previous studies evaluating the association between adiponectin and clinical outcomes in cardiovascular disease yielded conflicting results.
Are elevated serum levels of adiponectin associated with increased risk of MACCE and mortality in patients with first-ever acute ischemic stroke?
Cohort (n=4,274)
Yes
Are elevated serum levels of adiponectin associated with increased risk of MACCE and mortality in patients with first-ever acute ischemic stroke?
Hazard Ratio: 4.95 (95% CI 3.03–7.06)
Absolute Event Rate: 40.5% vs 8.1%
p-value: p=<0.001
Elevated serum adiponectin levels at admission independently predict a higher risk of MACCE and mortality in patients with acute ischemic stroke.
Should not yet change acute stroke management; leaves open adiponectin's incremental prognostic value.
BACKGROUND: Adiponectin plays role in multiple metabolic pathways. Previous studies in cardiovascular disease evaluated the association between adiponectin and clinical outcomes, yielding conflicting results. The aim of this study was to investigate the association of adiponectin with major adverse cardiovascular and cerebrovascular events (MACCE) and mortality in Chinese patients with first-ever acute ischemic stroke (AIS). METHODS: This was a prospective, multicenter cohort study. From September 2009 through October 2015, all patients with AIS from 3 stroke centers in Shandong were included. Serum levels of adiponectin at admission were tested. The prognostic role of adiponectin to predict the MACCE and mortality within 3 years was evaluated by multivariable-adjusted Cox proportional hazards models. RESULTS: This study included 4274 patients (median age 68 years [interquartile ranges {IQR}: 61-76]; 53.2% men). There were 794 deaths and 899 MACCE events. Higher serum levels of adiponectin on admission were found in patients with MACCE events and nonsurvivors (P < 0.001 and P < 0.001). In multivariable models adjusted for factors that confirmed in the univariate model, elevated serum levels of adiponectin were associated with a higher risk of MACCE (Quartile[Q]4 vs. Q1, Hazard ratio[HR] = 4.95 [95% confidence interval {CI}: 3.03-7.06]) and mortality (Q4 vs. Q1, HR = 5.63 [95% CI 3.15-7.99]). Adiponectin improved the prognostic value of the National Institutes of Health Stroke Scale (NIHSS) to predict MACCE (combined areas under the curve [AUC], 0.76; 95% CI 0.68-0.88; P = 0.001) and mortality (0.78[0.69-0.91]; P < 0.01). Subgroups analysis indicated that the prognostic role of adiponectin was more pronounced in women and patients with high levels of N-terminal-pro B-type natriuretic peptide(NT-pro BNP) (P < 0.001 and P < 0.001). CONCLUSIONS: Elevated serum levels of adiponectin were associated with a higher risk of MACCE and mortality independent of traditional risk factors in ischemic stroke patients.
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Tu et al. (2020) conducted a cohort in Acute ischemic stroke (AIS) (n=4,274). Elevated serum adiponectin levels vs. Lowest quartile of serum adiponectin was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) (HR 4.95, 95% CI 3.03-7.06, p=<0.001). Elevated serum levels of adiponectin (highest vs. lowest quartile) were associated with a significantly higher risk of major adverse cardiovascular and cerebrovascular events (HR 4.95) in patients with acute ischemic stroke.
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