We sought to examine the relationship of adiponectin with coronary atherosclerotic plaque morphology in patients with stable typical or atypical chest pain. There is increasing recognition that lesion composition rather than size determines the acute complications of atherosclerotic disease. Low serum adiponectin levels are associated with coronary artery disease and future incidence of acute coronary syndrome. The impact of adiponectin on lesion composition still remains to be determined. Serum adiponectin levels were determined in 303 patients with stable typical or atypical chest pain, who underwent dual-source multi-slice CT-angiography to exclude coronary artery stenosis. Atherosclerotic plaques were classified as calcified, mixed or non-calcified plaques. In bivariate analysis adiponectin levels were inversely correlated with total coronary plaque burden (r=−0.22, p<0.0001), mixed (r=−0.20, p=0.0007) and non-calcified plaques (r=−0.18, p=0.003). No correlation was seen with calcified plaques (r=−0.05, p=0.39). In a fully adjusted multivariate model containing age, sex, body mass index, hypertension, diabetes mellitus, smoking, family history of coronary artery disease, LDL-cholesterol, HDL-cholesterol, triglycerides, hsCRP levels, medication and pericardial adipose tissue volume, adiponectin levels remained predictive of total plaque burden (estimate: −0.035, 95% CI: −0.051 to −0.019, p<0.0001), mixed (estimate: −0.083, 95% CI: −0.127 to −0.039, p=0.0002) and non-calcified plaques (estimate: −0.076, 95% CI: −0.114 to −0.038, p=0.0001). Since the majority of coronary plaques were calcified plaques, adiponectin levels account for only 3% of the variability in total plaque number. In contrast, adiponectin accounts for approximately 20% of the variability in mixed and non-calcified plaque burden. Adiponectin levels predict mixed and non-calcified coronary atherosclerotic plaque burden. Low adiponectin levels may contribute to coronary plaque vulnerability and may thus play a role in the pathophysiology of acute coronary syndrome.
Total coronary atherosclerotic plaque burden is associated with myocardial ischemia in non-obstructive coronary artery disease
