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Research recently presented at the American Heart Association Scientific Sessions, held November 12–15 in Chicago, offered surprisingly different results to different groups of patients. Healthy middle-aged men with low levels of adiponectin could be at risk of developing type 2 diabetes, and patients with type 2 diabetes and an accompanying high-risk comorbidity are not properly managed when it comes to health care. There was good news, however, for patients with cardiometabolic markers who undergo bypass surgery.
LOW ADIPONECTIN AND HEALTHY MEN
Adiponectin is one of several hormones produced by adipose tissue. Appreciation for this hormone and its role in cardiometabolic disorders has grown since its discovery in the mid-1990s. Research suggests that adiponectin reduces insulin resistance and the production of glucose, has a beneficial effect on lipid metabolism, and has anti-inflammatory and antiatherogenic effects.
Wolfgang Koenig, MD, of University of Ulm Medical Center in Germany, and colleagues studied adiponectin in 887 apparently healthy men, age 45–65 years, without diabetes.1 During the 6-year follow-up period, 115 of the men developed diabetes.
Participants were sorted into tertiles based on their level of adiponectin. Analysis of the data revealed a "significant inverse relationship" between adiponectin and the development of diabetes. Men in the highest tertile of adiponectin levels had about half the risk of diabetes as men in the lowest tertile.
Analysis of associated risk factors showed a strong linkage with HDL cholesterol. Men with low adiponectin and low HDL cholesterol were about 2.5 times more likely to develop diabetes than men with the highest levels.
"Based on these data, the protective effect of high serum concentrations of adiponectin might be explained by its strong correlation with HDL cholesterol," Koenig says.
About 20% of the randomly selected study participants had low levels of both adiponectin and HDL cholesterol, according to Koenig.
"People with low adiponectin and low HDL [cholesterol] may be a subgroup with increased risk of diabetes," he says. "Further research is required to elucidate the role of adiponectin in the pathogenesis of diabetes and coronary heart disease."
MISMANAGED DIABETES IN HIGH-RISK PATIENTS
Patients with type 2 diabetes often are not well managed, even when they have a high-risk comorbidity such as congestive heart failure, according to new research reported at the scientific sessions.
An analysis of data from the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI) heart failure study revealed that few patients with type 2 diabetes are treated to reach recommended therapeutic targets.2
"Diabetes mellitus patients with congestive heart failure are at particularly high risk of cardiovascular events," says Aldo P. Maggioni, MD, of the Italian Association of Hospital Cardiologists Research Center in Florence, who presented the results.
GISSI included 7,046 participants in a heart failure study. All the patients were treated in Italian medical centers. Maggioni says the study shows that people with diabetes have more advanced heart failure, with an increased prevalence of ischemia and comorbidities such as stroke, high blood pressure, peripheral vascular disease, and chronic obstructive pulmonary disease, than people without the disease.
In addition, data compiled by Maggioni and colleagues show that people with diabetes and heart failure are more likely than people without diabetes to have renal dysfunction and a lower glomerular filtration rate, anemia, and elevated white blood cell counts. People with diabetes and heart failure were more likely than those without diabetes to be prescribed diuretics, aspirin, and nitrates, but were less likely to be prescribed ACE inhibitors or beta-blockers.
Despite the acute nature of their illness, people with diabetes often received inadequate care, Maggioni says. Other conclusions in the GISSI series include:
100
mg/dl, and 13.3% reached the target of 70 mg/dl. 140/90 mmHg, and only 30% had
a blood pressure 130/80 mmHg. 110 mg/dl, and
another 15% had levels of 111–126 mg/dl. Only 1.3% of patients studied reached all recommended treatment targets. "Diabetic patients, even in a very high-risk condition such as chronic heart failure, seem to be not appropriately managed," Maggioni says.
The findings "raise some concerns about the real applicability of current guidelines in clinical practice," he concludes.
BYPASS SURGERY IMPROVES RISK MARKERS
Aside from its ability to reduce excess body weight and improve glycemic control, gastric bypass surgery has a beneficial effect on several cardiometabolic markers, according to clinical research presented at the scientific sessions.
Internal medicine residents John Scrocco, MD, and Phillip J. Habib, MD,
both of Northeastern Ohio Universities College of Medicine in Rootstown,
presented the results of a study of 50 patients who underwent Roux-en-Y
gastric bypass
surgery.3 All
patients had a body mass index (BMI) 
40 or a BMI of 35 and medical
comorbidities.
|
Measurements taken 6 months before and after the surgery showed a significant drop in total cholesterol, triglycerides, LDL cholesterol, C-reactive protein, carotid intimamedia thickness, and brachial flow mediated dilatation.
Gastric bypass surgery "results in a significant improvement in
inflammatory, structural, and functional markers of atherosclerosis as early
as 6 months following surgery," according to Scrocco. 
References
2. Maggioni AP, Latini R, Centonze G, et al., on behalf of the GISSI-HF investigators: Diabetes is not appropriately managed even in the very high risk patients with heart failure: Data from the GISSI Heart Failure trial (Abstract). Circulation 114 (Suppl. II): II-844, 2006.
3. Scrocco J, Habib PJ, Vanek V, et al.: Gastric bypass surgery improves inflammatory, structural, and functional markers of coronary atherosclerosis (Abstract). Circulation 114 (Suppl. II):II -854, 2006.
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