Inflammation Research

, Volume 63, Issue 11, pp 961–968 | Cite as

Adiponectin-resistin index and its strong association with acute coronary syndrome in South Indian men

  • Prerna Singh
  • M. G. Sridhar
  • Medha Rajappa
  • J. Balachander
  • Tamilarasu Kadhiravan
Original Research Paper



India has the highest burden of acute coronary syndromes worldwide. Apart from certain lipid alterations that have been established to be definite risk factors, low level of adiponectin, high levels of resistin, and IL-6 have been shown to be risk factors for cardiovascular events. Insulin resistance is also a significant predictor of poor outcome in patients admitted with ACS.


69 male patients with ACS and 70 age-matched healthy males were recruited in the study. Insulin, total adiponectin, resistin, and IL-6 levels were assayed in all study subjects. Indices of insulin resistance and novel adipokine indices were calculated using standard formulae. Multiple logistic regression analysis was done to find out the best predictor of ACS.


Resistin, IL-6, insulin resistance indices, AR index, and IRAR index were found to be significantly higher, while insulin sensitivity indices and total adiponectin were found to be lower in cases, as compared with controls (p < 0.001). Insulin resistance was found to be higher in the admission sample, when compared to the fasting sample in patients with ACS (p = 0.01). On multivariate logistic regression analysis, HOMA-IR and AR index were found to be significantly associated with ACS. AR index was the best independent predictor of ACS, with the highest odds ratio (AR index: adjusted OR 17.528, p < 0.0001 versus HOMA-IR: adjusted OR 1.146, p = 0.001).


The present results implicate that adipokines are significantly associated with pathogenesis of ACS, warranting adequate and early appropriate treatment to reverse this metabolic dysregulation. In our study, AR index was the best predictor of ACS. Hence, the novel AR index might be useful in routine clinical practice for screening persons with increased risk of future development of ACS.


Acute coronary syndrome Adipokines Insulin resistance 



Acute coronary syndrome


Coronary artery disease


Unstable angina


Acute myocardial infarction


Tumor necrosis factor-α




Admission insulin resistance index


Fasting insulin resistance index

AR index

Adiponectin-resistin index

IRAR index

Insulin resistance index



We wish to thank Mr. Vengattaraman, Technical Assistant and Ms. Durgadevi T, Lab Technician for their help in assaying the study parameters by chemiluminescence and ELISA, respectively. We also thank Dr. Laxmisha Chandrashekar, Associate Professor of Dermatology, JIPMER, Puducherry for helping with the statistical analysis. Financial assistance from JIPMER, Puducherry in the form of Intramural Fund for this research work is gratefully acknowledged.

Conflict of interest

The authors report no conflict of interest related to this work.


  1. 1.
    Pischon T, Rimm EB. Adiponectin and risk of acute coronary syndromes: defining the obesity phenotype. Eur Heart J. 2007;28:274–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Gupta R, Joshi P, Mohan V, et al. Epidemiology and causation of coronary heart disease and stroke in India. Heart. 2008;94:16–26.PubMedCrossRefGoogle Scholar
  3. 3.
    Gupta Rajeev. Burden of coronary heart disease in India. Indian Heart J. 2005;57:632–8.PubMedGoogle Scholar
  4. 4.
    Wolk R, Berger P, Lennon RJ, Brilakis ES, Davison DE, Somers VK. Association between plasma adiponectin levels and unstable coronary syndromes. Eur Heart J. 2007;28:292–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Kumada M, Kihara S, Sumitsuji S, Kawamoto T, Matsumoto S, Ouchi N, et al. Association of hypoadiponectinemia with coronary artery disease in men. Arterioscler Thromb Vasc Biol. 2003;23:85–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Qiao X, Yang Y, Xu Z, Yang L. Relationship between resistin level in serum and acute coronary syndrome or stable angina pectoris. J Zhejiang Univ Sci B. 2007;8:875–80.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Chu S, Ding W, Li K, Pang Y, Tang C. Plasma resistin associated with myocardium injury in patients with acute coronary syndrome. Circ J. 2008;72:1249–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Alwi I, Santoso T, Suyono S, Sutrisna B, Kresno SB. The cut-off point of interleukin-6 level in acute coronary syndrome. Indones J Intern Med. 2007;39:174–8.Google Scholar
  9. 9.
    Ramachandran A, Chamukuttan S, Immaneni S, Shanmugam RM, Vishnu N, Viswanathan V, Jaakko T. High incidence of glucose intolerance in Asian-Indian subjects with acute coronary syndrome. Diabetes Care. 2005;28:2492–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Stubbs PJ, Alaghband-Zadeh J, Laycock JF, Collinson PO, Carter GD, Noble MIM. Significance of an index of insulin resistance on admission in non-diabetic patients with acute coronary syndromes. Heart. 1999;82:443–7.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Stubbs PJ, Laycock JF, Alaghband-Zadeh J, Carter GD, Noble MIM. Circulating stress hormone and insulin concentrations in acute coronary syndromes: identification of insulin resistance on admission. Clin Sci (Lond). 1999;96:595–6.CrossRefGoogle Scholar
  12. 12.
    Lau CH, Muniandy S. Novel adiponectin-resistin (AR) and insulin resistance (IRAR) indexes are useful integrated diagnostic biomarkers for insulin resistance, type 2 diabetes and metabolic syndrome: a case control study. Cardiovasc Diabetol. 2011;10:1–18.CrossRefGoogle Scholar
  13. 13.
    Killip T. III, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol. 1967;20:457–64.PubMedCrossRefGoogle Scholar
  14. 14.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Nakamura Y, Shimada K, Fukuda D, Shimada Y, Ehara S, Hirose M, et al. Implications of plasma concentrations of adiponectin in patients with coronary artery disease. Heart. 2004;90:528–33.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Krecki R, Krzeminska-Pakula M, Peruga JZ, Szczesniak P, Lipiec P, Wierzbowska-Drabik K, et al. Elevated resistin opposed to adiponectin or angiogenin plasma levels as a strong, independent predictive factor for the occurrence of major adverse cardiac and cerebrovascular events in patients with stable multi vessel coronary artery disease over 1-year follow-up. Med Sci Monit. 2011;17:CR26–32.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Wasim H, Al-Daghri NM, Chetty R, McTernan PG, Barnett AH, Kumar S. Relationship of serum adiponectin and resistin to glucose intolerance and fat topography in South-Asians. Cardiovasc Diabetol. 2006;5:1–5.CrossRefGoogle Scholar
  18. 18.
    Lewandowski KC, Szosland K, O’Callaghan C, Tan BK, Randeva HS, Lewinski A. Adiponectin and resistin serum levels in women with polycystic ovary syndrome during oral glucose tolerance test: a significant reciprocal correlation between adiponectin and resistin independent of insulin resistance indices. Mol Genet Metab. 2005;85:61–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Burnett MS, Lee CW, Kinnaird TD, et al. The potential role of resistin in atherogenesis. Atherosclerosis. 2005;182:241–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Tan J, Hua Q. Correlations between serum inflammation factors and left ventricular remodeling in acute ST segment elevation myocardial infarction. Yonsei Med J. 2012;53:501–7.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Reilly MP, Lehrke M, Wolfe ML, Rohatgi A, Lazar MA, Rader DJ. Resistin is an inflammatory marker of atherosclerosis in humans. Circulation. 2005;111:932–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Rubio-Guerra AF, Cabrera-Miranda LJ, Vargas-Robles H, Maceda-Serrano A, Lozano-Nuevo JJ, Escalante-Acosta BA. Correlation between levels of circulating adipokines and adiponectin/resistin index with carotid intima-media thickness in hypertensive type 2 diabetic patients. Cardiology. 2013;125:150–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Hameed IK, Rashid NF, Abed BA. Homestasis Model Assessment-Adiponectin ratio and Adiponectin-Resistin index as markers of insulin resistance in type 2 diabetes mellitus. J Fac Med Baghdad. 2013;55:175–8.Google Scholar
  24. 24.
    Chavarria-Ávila E, Ruíz Quezada SL, Guzmán-Ornelas MO, Castro-Albarrán J, Aguilar Aldrete ME, Vásquez-Del Mercado M, et al. Association of resistin gene 3′UTR + 62G > A polymorphism with insulin resistance, adiposity and the adiponectin-resistin index in mexican population. Nutr Hosp. 2013;28:1867–76.PubMedGoogle Scholar

Copyright information

© Springer Basel 2014

Authors and Affiliations

  • Prerna Singh
    • 1
  • M. G. Sridhar
    • 1
  • Medha Rajappa
    • 1
  • J. Balachander
    • 2
  • Tamilarasu Kadhiravan
    • 3
  1. 1.Department of BiochemistryJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia
  2. 2.Department of CardiologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia
  3. 3.Department of MedicineJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia

Personalised recommendations