To the editor:

I read with great interest the article by Justyna Domienik-Karłowicz et al. [1] that assess the emerging biochemical markers of arterial remodeling in female patients with morbid obesity before and after surgical treatment, compared to a control group. I am satisfied with the clear evidence of the reduction in adiponectin, matrix metalloproteinase (MMP)-2, and MMP-9 levels in the obese patients after bariatric surgery. However, I have some queries on the definition of hypoadiponectinemia. Their study demonstrated that hypoadiponectinemia was diagnosed in 90 % of patients who underwent bariatric surgery and 20 % subjects in the control group. In this study, hypoadiponectinemia was defined as adiponectin levels of <7000 ng/mL. According to observations by Schondrof et al. [2], these adiponectin levels were a predictor of very high risk of cardiovascular complications. It is well established that adiponectin levels are higher in women and lean individuals [3, 4]. Moreover, a recent study demonstrated ethnic variations in circulating adipokine including adiponectin levels before and after adjustment for BMI [5]. In this context, it is suggested that hypoadiponectinemia would define by using sex and ethnic-specific levels. In addition, it remains inconclusive whether adiponectin levels can predict future risk of coronary heart disease in women [6, 7]. Further study is necessary to clarify the association between adiponectin and a predictor of cardiovascular disease.