Relation of Plasma Total and High-Molecular-Weight Adiponectin to New-Onset Heart Failure in Adults ≥ 65 Years of Age (From the Cardiovascular Health Study)

Adiponectin exhibits cardioprotective properties in experimental studies, but elevated levels have been linked to increased mortality in older adults and patients with chronic heart failure (HF). The adipokine’s association with new-onset HF remains less well defined. We investigated the associations of total and HMW adiponectin with incident HF (n=780) and, in a subset, echocardiographic parameters in a community-based cohort of adults 65 and older. Total and high molecular weight (HMW) adiponectin were measured in 3,228 subjects without prevalent HF or CVD. The relationships of total and HMW adiponectin with HF were nonlinear, with significant associations observed only above their medians (12.4 and 6.2 mg/L, respectively). After adjustment for potential confounders, the hazard ratios (HR) per standard deviation (SD) increment in total adiponectin were 0.93 (95% confidence interval [CI]=0.72–1.21) below the median and 1.25 (95% CI=1.14–1.38) above it. There was a suggestion of effect modification by body mass index (BMI), whereby the association appeared strongest among participants with lower BMIs. Consistent with the HF findings, higher adiponectin tended to be associated with left ventricular systolic dysfunction and left atrial enlargement. Results were similar for HMW adiponectin. In conclusion, total and HMW adiponectin showed comparable relationships with incident HF in this older cohort, with a threshold effect of increasing risk occurring at their median concentrations. High levels of adiponectin may mark or mediate age-related processes that lead to HF in older adults.