Fetuin-A, type 2 diabetes, and risk of cardiovascular disease in older adults: The cardiovascular health study

OBJECTIVE-Fetuin-A, a hepatic secretory protein that simultaneously inhibits arterial calcification and insulin action, is associated with type 2 diabetes, but its association with cardiovascular disease (CVD) is uncertain. Preliminary studies suggest that the association of fetuin-A with CVD might differ among individuals with or without type 2 diabetes. RESEARCHDESIGNANDMETHODS-Thiswas a prospective study of 3,810 communityliving individuals older than 65 years (511 with type 2 diabetes) and free of CVD in 1992 when fetuin-A levels weremeasured. Participants were followed-up for incident CVD through June 2008. RESULTS-Mean age was 75 years, and 61% were women; 1,456 participants had an incident CVD event (248 among individuals with type 2 diabetes). The association of fetuin-A with CVD wasmodified by type 2 diabetes (P interaction = 0.02). Higher fetuin-A was associated with lower CVD risk among persons without type 2 diabetes [hazard ratio per SD 0.1 g/L higher fetuin-A, 0.93 (95% CI, 0.88-0.99)], whereas a trend in the opposite direction was observed among individuals with type 2 diabetes, although it was not statistically significant [1.07 (0.93- 1.22)]. Among individuals without type 2 diabetes, similar effect modification was observed by obesity and insulin resistance. Consistently, higher fetuin-A was associated with lower CVD risk only in the subgroups without obesity or with HOMA-IR below the median [0.91 (0.85- 0.97) and 0.87 (0.79-0.95), respectively]. CONCLUSIONS-The association of fetuin-A with risk of CVD differs among elderly individuals with and without insulin resistance or type 2 diabetes.