Fetuin-A, Type 2 Diabetes, and Risk of Cardiovascular Disease in Older Adults: The Cardiovascular Health Study
Jensen, Majken K.
Bartz, Traci M.
Mukamal, Kenneth J.
Kizer, Jorge R.
Tracy, Russell P.
Zieman, Susan J.
Rimm, Eric Bruce::0ab2926c8242f35e5a982e3cf59f4987::600
Siscovick, David S.
Ix, Joachim H.
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CitationJensen, M. K., T. M. Bartz, K. J. Mukamal, L. Djousse, J. R. Kizer, R. P. Tracy, S. J. Zieman, et al. 2012. “Fetuin-A, Type 2 Diabetes, and Risk of Cardiovascular Disease in Older Adults: The Cardiovascular Health Study.” Diabetes Care 36 (5): 1222–28. https://doi.org/10.2337/dc12-1591.
AbstractOBJECTIVE-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.RESEARCH DESIGN AND METHODS-This was a prospective study of 3,810 community-living individuals older than 65 years (511 with type 2 diabetes) and free of CVD in 1992 when fetuin-A levels were measured. 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 was modified 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% Cl, 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.
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