Interventions to increase adiponectin may be associated with increased coronary heart disease in older adults

Evaluation of: Kizer JR, Barzilay JI, Kuller LH, Gottdiener JS: Adiponectin and risk of coronary heart disease in older men and women. J. Clin. Endocrinol. Metab. 93, 3357-3364 (2008). Adiponectin has insulin sensitizing, anti-inflammatory and antiatherogenetic properties. On the basis of this, it is proposed that adiponectin could protect against the development of coronary heart disease (CHD). However, in a nested case-control population-based study, it was demonstrated that high not low adiponectin is associated with increased CHD risk in older adults, challenging earlier studies and suggesting higher adiponectin to be associated with lower risk of CHD. The increased risk is not explained by renal dysfunction or weight loss, factors that may increase adiponectin and mortality. The reason underlying this paradoxical finding in older adults is unclear. Future epidemiological and clinical studies are required to better address the potential mechanisms underlying the link between elevated adiponectin and CHD risk in older adults, as well as the role of adiponectin in atherosclerosis. Until we unravel this paradox, therapeutic interventions aimed at enhancing adiponectin levels for cardiovascular disease prevention in older subjects may be undesirable.