title: Plasma fetuin-a levels and the risk of myocardial infarction and ischemic stroke.
abstract: BACKGROUND
  Fetuin-A, a protein almost exclusively secreted by the liver, induces insulin resistance and subclinical inflammation in rodents. Circulating fetuin-A levels are elevated in humans with metabolic syndrome and insulin resistance, conditions that are associated with increased risk of cardiovascular disease.
  
  
  RESULTS
  We investigated the association between fetuin-A levels and the risk of future myocardial infarction (MI) and ischemic stroke (IS) in a case-cohort study based on the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study comprising 27 548 middle-aged subjects of the general population. Fetuin-A levels were measured in plasma of 227 individuals who developed MI, in 168 who developed IS, and in 2198 individuals who remained free of cardiovascular events during a mean follow-up of 8.2+/-2.2 years. Individuals in the highest compared with the lowest quintile of plasma fetuin-A had significantly increased risks of MI (relative risk, 3.80; 95% confidence interval, 2.37 to 6.10; P for trend <0.0001) and IS (relative risk, 3.93; 95% confidence interval, 2.17 to 7.12; P for trend <0.0001) after adjustment for sex and age. Additional adjustment for smoking status, body mass index, waist circumference, alcohol consumption, educational attainment, physical activity, hypertension, diabetes mellitus, total and high-density lipoprotein cholesterol, and C-reactive protein only moderately attenuated these risks (MI: relative risk, 3.25; 95% confidence interval, 2.01 to 5.28; P for trend <0.0001; IS: relative risk, 3.78; 95% confidence interval, 2.06 to 6.94; P for trend <0.0001).
  
  
  CONCLUSIONS
  Our data provide evidence for a link between high plasma fetuin-A levels and an increased risk of MI and IS. Therefore, more research is warranted to determine the role of fetuin-A in the pathophysiology of cardiovascular disease.
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany. Weikert@dife.de
authors.forename: Cornelia
authors.initials: C
authors.lastname: Weikert
authors.forename: Norbert
authors.initials: N
authors.lastname: Stefan
authors.forename: Matthias B
authors.initials: MB
authors.lastname: Schulze
authors.forename: Tobias
authors.initials: T
authors.lastname: Pischon
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Joost
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Häring
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Andreas
authors.initials: A
authors.lastname: Fritsche
mesh_terms: D002545:Brain Ischemia; D005500:Follow-Up Studies; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011237:Predictive Value of Tests; D012306:Risk; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins