Differential Therapeutic Modulations of Adiponectin: Beneficial, Adverse, and Context-Dependent Effects in Chronic Coronary Syndromes

Different degrees of chronic metabolic inflammation and adiponectin resistance significantly contribute to the development of cardiovascular diseases and metabolic syndrome. Adiponectin is a unique pleiotropic adipokine with anti-inflammatory, anti-atherogenic, and anti-diabetic effects. In early metabolic dysfunction, adiponectin levels increase as a compensatory response, whereas in advanced coronary disease, hypoadiponectinemia develops due to adiponectin resistance. The aim of this review is to highlight how contemporary cardiovascular therapies alter adiponectin levels and why this is clinically important for reducing low-grade systemic and vascular inflammation in chronic coronary syndromes. Evidence suggests that drug classes such as PPAR agonists, SGLT2 inhibitors, GLP-1 receptor agonists, RAAS blockers, metformin, certain statins, and fibrates may increase adiponectin levels, although effects vary by drug class and disease stage. Although adiponectin represents a promising therapeutic target for the treatment of coronary syndromes, further experimental and pharmacological research is necessary to develop drugs based on its mechanism of action.