Plasma adiponectin, body mass index, and mortality in patients with chronic heart failure

Background - Recent studies have suggested that higher body mass index (BMI) is associated with improved prognosis in chronic heart failure ( CHF). The adipocytokine adiponectin is inversely associated with BMI, and in healthy subjects, low adiponectin is a predictor of mortality. In a prospective study, we therefore evaluated the association between plasma adiponectin levels and mortality among patients with CHF. Methods and Results - In 195 CHF patients ( age 69.3 +/- 10.2 years, BMI 27.3 +/- 5.2 kg/m(2), left ventricular ejection fraction 30 +/- 8.9%, mean +/- SD), plasma adiponectin and N-terminal pro brain natriuretic peptide (NT- proBNP) were measured at baseline. Adiponectin was positively associated with NT- proBNP (beta = 0.47, P < 0.001), and both biomarkers were negatively associated with BMI ( beta = -0.43, P < 0.001 for adiponectin and beta = -0.38, P < 0.001 for NT- proBNP, respectively) During a median follow-up of 2.6 years, 46 (23.5%) of the patients died. After adjustment for clinical variables associated with CHF severity ( age, systolic blood pressure, left ventricular ejection fraction < 25%, duration of CHF, and creatinine clearance) and for NT- proBNP, the hazard ratio of mortality for values in the 2 upper tertiles relative to the lowest tertile of adiponectin was 3.23 ( P = 0.032). BMI predicted mortality independently of clinical parameters of CHF severity ( hazard ratio = 0.63, P = 0.012), but this association became insignificant after additional adjustment for NT-proBNP ( hazard ratio = 0.74, P = 0.13). Conclusions - A high adiponectin level was a predictor of mortality, independent of risk markers of CHF severity, presumably because of its role as a marker for wasting. BMI was also associated with mortality, but a part of this relation may be mediated by adiponectin and NT-proBNP levels.