In a clinical setting, increased skeletal muscle adiponectin expression in congestive heart failure patients (fivefold higher than in healthy subjects) was characterized by downregulation of AdipoR1 that was most probably linked to deactivation of the peroxisome proliferator-activated receptor-alpha (PPAR-alpha)/AMP-activated protein kinase pathway38. This evidence concerns the gene ADIPOR1 and congestive heart failure.