title: The prognostic role of the adiponectin levels in atrial fibrillation.
abstract: BACKGROUND
  Patients with atrial fibrillation (AF) have a high morbidity and mortality from vascular events, even despite oral anticoagulation (OAC). Rather than being a risk factor, AF has been proposed as a risk marker, being a signal of advanced atherosclerosis. Circulating adiponectin levels, a cytokine with anti-inflammatory and cardioprotector roles, are related to different atherosclerotic risk factors. The aim is to evaluate whether plasma adiponectin can be predictive of cardiovascular risk in anticoagulated patients with AF.
  
  
  METHODS
  We included 918 stable anticoagulated out patients with nonvalvular AF [50·1% male; median age 76 (70-80) years; median score for the stroke risk stratification scheme CHA(2) DS(2) -VASc was 4 (3-5)]. Plasma adiponectin was determined by ELISA. Clinical follow-up and cardiovascular adverse events were recorded.
  
  
  RESULTS
  After a median follow-up of 956 (784-1085) days, 113 cardiovascular events were recorded (annual rate 4·70%/year) and 99 patients died (rate 4·12%/year). Low plasma adiponectin (< 4444 ng/mL) was significantly associated with major cardiovascular events in female patients [HR 2·96 (95%CI 1·78-4·92)]; P < 0·001, even after adjusting for clinical confounder factors. Adiponectin was neither predictive of stroke/thromboembolism nor all-cause mortality in females, nor for any end-point in males.
  
  
  CONCLUSIONS
  Adiponectin is suggested as an independent prognostic biomarker for cardiovascular events in anticoagulated female patients with AF. Our data reinforce the importance of AF as a risk marker of atherosclerotic vascular damage.
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia 30008, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Hernández-Romero
authors.forename: Eva
authors.initials: E
authors.lastname: Jover
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
authors.forename: Juan A
authors.initials: JA
authors.lastname: Vilchez
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernandez
authors.forename: Marta
authors.initials: M
authors.lastname: Romera
authors.forename: Vicente
authors.initials: V
authors.lastname: Vicente
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldán
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000097:blood* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D052242:Adiponectin; D000925:Anticoagulants; D015415:Biomarkers