title: Serum adiponectin concentration is a positive predictor of all-cause and cardiovascular mortality in type 1 diabetes.
abstract: BACKGROUND
  Adiponectin is widely regarded as an anti-atherogenic, antioxidant and anti-inflammatory molecule. However, adiponectin concentration is paradoxically increased in individuals with type 1 diabetes, in whom it is positively associated with adverse clinical outcomes.
  
  
  OBJECTIVE
  To explore the association between serum adiponectin concentration and mortality outcomes in adults with type 1 diabetes.
  
  
  METHODS
  Multicentre prospective cohort study.
  
  
  METHODS
  Primary and tertiary care.
  
  
  METHODS
  Finnish adults with type 1 diabetes (n= 2034). Main outcome measures.  All-cause and cardiovascular mortality. Independent predictors of mortality were determined using the Cox and the Fine and Gray competing risks proportional hazards models.
  
  
  RESULTS
  During a median of 11 years of follow-up, there were 173 deaths (8.5%, 1.0 per hundred person-years). Adiponectin was linearly associated with all-cause mortality [Cox model: hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.01-1.03, P<0.001] and cardiovascular mortality (Fine and Gray model: HR 1.02, 95% CI 1.00-1.04, P=0.035); patients with the highest adiponectin concentrations had the shortest survival. The mortality risk associated with adiponectin was independent of glycaemic and lipid control, pre-existing cardiovascular disease, markers of inflammation and the presence and severity of kidney disease.
  
  
  CONCLUSIONS
  Although adiponectin is generally considered to be a protective molecule, increased concentrations of adiponectin in type 1 diabetes are independently associated with all-cause and cardiovascular mortality. Moreover, the fact that this association was observed for the first time in patients with normal urinary albumin levels, who have few comorbidities, suggests that adiponectin is specifically linked with vascular damage in type 1 diabetes.
authors: Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.
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authors: Forsblom
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authors: Moran
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authors: Saraheimo
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authors: Thorn
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authors: Wadén
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