Adiponectin is considered to have anti-inflammatory, insulin-sensitizing, and antiatherosclerotic properties. In the present prospective study, the relationship between metabolic syndrome (Adult Treatment Panel III) and adiponectin plasma levels and the relationship between plasma adiponectin levels and future cardiovascular events were investigated.

A case-cohort study of 431 patients with clinical evident vascular disease from the Second Manifestations of ARTerial Disease study. The relationship between adiponectin plasma levels and new vascular events was investigated with Cox regression, adjusted for potential confounders and effect modifiers (age, sex, renal function [modification of diet in renal disease], body mass index, high sensitive C-reactive protein, use of angiotensin converting enzyme-inhibition and/or AII antagonists, and presence of metabolic syndrome or impaired renal function).

Plasma adiponectin levels were lower in patients with metabolic syndrome as compared with patients without (7.9 ± 0.3 vs 5.2 ± 0.3 μg/mL) and decreased with the number of components. During a mean follow-up of 2.3 years, 216 patients had a new cardiovascular event. Lower adiponectin plasma levels were associated with a lower risk for future cardiovascular events (hazard ratio 0.50, 95% confidence interval 0.25-0.99). This relationship was not influenced by renal function, body mass index, and renin-angiotensin system–blocking agents or modified by metabolic syndrome and impaired renal function.

In patients with clinical evident vascular disease, lower adiponectin levels were associated with a lower cardiovascular risk. Therefore, it may be hypothesized that the potential antiatherosclerotic properties of adiponectin do not apply for patients with already established vascular disease.