Proinflammatory Cytokines, Adiponectin, and Increased Risk of Primary Cardiovascular Events in Diabetic PatientsWith orWithout Renal Dysfunction Results from the ESTHER study

OBJECTIVEdInflammatory processes contribute to both diabetes and cardiovascular risk. We wanted to investigate whether circulating concentrations of proinflammatory immune medi-ators and adiponectin in diabetic patients are associated with incident cardiovascular events. RESEARCH DESIGN AND METHODSdIn 1,038 participants with diabetes of the population-based ESTHER study, of whom 326 showed signs of renal dysfunction, Cox pro-portional hazards models were used to estimate hazard ratios (HRs) and 95 % CIs for the asso-ciation of increasing concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), IL-18, macrophage migration inhibitory factor (MIF), adiponectin, and leptin with cardiovascular events (myocardial infarction, stroke, or fatal cardiovascular event) during a follow-up period of 8 years. RESULTSdDuring follow-up, 161 subjects with diabetes experienced a primary cardiovascular event. Proinflammatory markers were not associated with a higher risk for primary cardiovascular events in the total study population after adjustment for multiple confounders. However, IL-6 and MIF were associated with cardiovascular events in subjects with renal dysfunction (HR for the comparison of top vs. bottom tertile 1.98 [95 % CI 1.12–3.52], P [trend] = 0.10 for IL-6; 1.4