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

Majken K. Jensen, Traci M. Bartz, Kenneth J. Mukamal, Luc Djoussé, Jorge R. Kizer, Russell P. Tracy, Susan J. Zieman, Eric B. Rimm, David S. Siscovick, Michael Shlipak, Joachim H. Ix

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1222-1228
Number of pages7
JournalDiabetes care
Volume36
Issue number5
DOIs
StatePublished - May 1 2013

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ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Jensen, M. K., Bartz, T. M., Mukamal, K. J., Djoussé, L., Kizer, J. R., Tracy, R. P., Zieman, S. J., Rimm, E. B., Siscovick, D. S., Shlipak, M., & Ix, J. H. (2013). Fetuin-A, type 2 diabetes, and risk of cardiovascular disease in older adults: The cardiovascular health study. Diabetes care, 36(5), 1222-1228. https://doi.org/10.2337/dc12-1591