Despite the rising prevalence of atrial fibrillation (AF) throughout the world, the prevention of AF has received relatively little attention. The first step in effective prevention is the accurate identification of persons at risk.1 Biomarkers have been shown to have an important role in risk prediction in other cardiovascular diseases (CVDs), yet few biomarkers, if any, have shown promise in identifying patients at risk for AF. In addition to the challenges of risk prediction, the development of therapeutic interventions to prevent AF is limited by our poor understanding of the factors that promote atrial fibrosis and maladaptive remodelling.

Adiponectin is a peptide hormone that has gained attention as a risk marker for CVD and, potentially, AF. Although produced by adipocytes, adiponectin levels fall with increasing adiposity due to obesity-related changes in adipocyte function. Adiponectin is found abundantly in the circulation and has insulin-sensitising, anti-inflammatory and anti-atherosclerotic effects.2 Despite its beneficial metabolic properties, higher adiponectin levels have been associated with worse cardiovascular outcomes, including coronary heart disease,3 heart failure4 and all-cause mortality.5 To date, there is conflicting evidence regarding adiponectin and the risk of AF.6 ,7

In their Heart publication, Macheret et al8 provide further support for a link between adiponectin and AF. The authors examined the association between adiponectin levels and incident AF in 3190 patients aged over 65 years from the Cardiovascular Health Study. Patients with prevalent CVD and AF were excluded. Total and …