Adiponectin, diabetes and ischemic heart failure: a challenging relationship

We evaluated the level of adiponectin in patients with ischemic HF, with and without type 2 diabetes, to elucidate whether the metabolic syndrome was able to influence the relationship between AD and HF.We demonstrated that AD rises in patients with advanced HF, but to a lesser extent in diabetics than in non-diabetics. Diabetic patients with reduced systolic performance orchestrated a slower rise of AD which began only in face of overt HF. The different behavior of AD in the presence of diabetes was not entirely explained by differences in body mass index. In addition, NT-proBNP, the second strongest predictor of AD, did not differ significantly between diabetic and non-diabetic patients. These data indicate that some other mechanisms are involved in the regulation of AD in patients with type 2 diabetes and coronary artery disease.AD rises across chronic heart failure stages but this phenomenon is less evident in type 2 diabetic patients. In the presence of diabetes, the progressive increase of AD in relation to the severity of LV dysfunction is hampered and becomes evident only in overt HF.The adipose tissue should not be regarded as a simple site of lipid storage [1]; indeed it is able to secrete several peptides with hormonal properties that are involved in energy homeostasis as well as modulation of inflammation and regulation of many immunological mechanisms [2]. This heterogeneous group of hormones is named adipokines. Among these, adiponectin (AD) is by far the most abundant protein secreted by the adipose tissue [3]. Although it is produced almost exclusively by adipocytes, plasma levels of AD are found to be inversely correlated to visceral adiposity and body mass index (BMI) [3]. AD promotes peripheral insulin sensitivity [4] and inhibition of liver gluconeogenesis [5]. As a matter of fact, hypoadiponectinemia is known to be the molecular link between obesity and insulin-resistance, at the base of metabolic syndrome [2]. AD is able to predict diabetes ons