High adiponectin and increased risk of cardiovascular disease and mortality in asymptomatic older men: does NT-proBNP help to explain this association?

Background: Raised adiponectin is associated with increased rather than decreased risk of cardiovascular disease (CVD) and mortality at older age. We examined whether N-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of cardiac dysfunction, may help explain this relationship. Methods and results: A prospective study of 2879 men aged 60–79 years with no history of CVD at baseline followed-up for a mean of 9 years during which there were 196 major coronary heart disease events (fatal and non-fatal myocardial infarction) and 667 deaths (including 225 CVD deaths), whereas adiponectin concentration was inversely associated with several conventional CVD risk factors; it was significantly and positively associated with NT-proBNP concentration. After adjustment for several vascular risk factors, including renal function and muscle mass, relative risks associated with a top third versus bottom third comparison of adiponectin concentration were 1.51 (1.02–2.23) for coronary heart disease, 1.67 (1.15–2.41) for CVD mortality and 1.41 (1.13–1.95) for all cause mortality. Upon further adjustment for NT-proBNP, these relative risks attenuated to 1.31 (0.88–1.94), 1.31 (0.90–1.91) and 1.26 (1.01–1.59), respectively. Conclusion: We show for the first time that concomitantly elevated NT-proBNP concentration, at least, partially explains the apparently positive relationship between adiponectin concentration and risk of CVD and mortality in asymptomatic elderly men.