The Association of Fetuin-A With Cardiovascular Disease Mortality in Older Community-Dwelling Adults: The Rancho Bernardo Study

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• 作者：Gail A. Laughlin ; PhD^鈦?/sup> ; ^{glaughlin@ucsd.edu} ; Kevin M. Cummins ; MS^鈦?/sup> ; Christina L. Wassel ; PhD^&dagger ; ; Lori B. Daniels ; MD ; MAS^鈦?/sup> ; ^&Dagger ; ; Joachim H. Ix ; MD ; MAS^&dagger ; ; ^§ ; ; ^鈭?/sup>
• 关键词：cardiovascular disease ; diabetes mellitus ; epidemiology ; fetuin-A ; mortality
• 刊名：Journal of the American College of Cardiology
• 出版年：2012
• 期刊代码：201_07351097
• 类别：med
• 出版时间：8 May, 2012
• 卷：59
• 期：19
• 页码：1688-1696
• 文件大小：594 K

摘要

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Objectives

The goal of this study was to evaluate the prospective association of fetuin-A levels with cardiovascular disease (CVD) mortality.

Background

Fetuin-A is a circulating inhibitor of calcium deposition in the vasculature and of insulin action in muscle and fat, and may be involved in the pathogenesis of CVD.

Methods

This is a population-based prospective study of 633 men and 1,025 women (median age = 73 years) who had fetuin-A levels and CVD risk factors evaluated in 1992 to 1996 and were followed for vital status through 2010.

Results

Plasma fetuin-A (g/l 卤 SD) was highest in women using oral estrogens (0.55 卤 0.12), intermediate for women not using oral estrogens (0.51 卤 0.10), and lowest for men (0.50 卤 0.10), p < 0.001. Lower fetuin-A levels were associated with older age, but with lower levels of other CVD risk factors including adiposity, blood pressure, lipids, triglycerides, and insulin resistance (all p < 0.01). During the median 12-year follow-up, 273 deaths were attributed to CVD. The association of fetuin-A with CVD mortality differed by diabetes status (p for interaction = 0.003). Adjusting for age, sex, oral estrogens, and lifestyle, the hazard ratio for CVD mortality comparing the lowest fetuin-A quartile with all higher values was 1.76 (95%confidence interval [CI]: 1.34 to 2.31; p < 0.001) for participants without diabetes and 0.43 (95%CI: 0.19 to 0.98; p = 0.046) for participants with diabetes.

Conclusions

Low fetuin-A levels predicted greater risk for CVD mortality in older adults without diabetes, but were associated with reduced risk of CVD death in those with diabetes. Fetuin-A may provide novel insight into mechanisms leading to CVD death in those with versus without diabetes.