title: Associations of fetuin-A levels with vascular disease in type 2 diabetes patients with early diabetic nephropathy.
abstract: BACKGROUND
  Ambigous results exist on fetuin-A as marker for vascular disease in type 2 diabetes. This study aims to define the role of fetuin-A as marker for micro- and macrovascular disease in a high risk population of patients with type 2 diabetes mellitus and early diabetic nephropathy.
  
  
  METHODS
  Fetuin-A serum levels were assessed by ELISA in a cross-sectional setting in 153 patients with type 2 diabetes. Associations of fetuin-A with metabolic, inflammatory and vascular markers were studied. Atherosclerotic burden was assessed by ankle-brachial-index (ABI) as well as detection of common carotid artery intima-media thickness (IMT).
  
  
  RESULTS
  Levels of fetuin-A were lower in male than in female patients (0.49 ± 0.15 vs. 0.56 ± 0.20 g/L, p = 0.02). In addition, there was an inverse correlation with age (r = -0.20, P = 0.01). Bivariate correlations adjusted for age and gender revealed no significant correlations with metabolic parameters, except for a weak inverse correlation with serum adiponectin (r = -0.19, p = 0.02). Regarding parameters of micro- and macrovascular disease, fetuin-A was significantly associated with ABI (r = 0.18, p = 0.04), while there was no association with IMT (r = -0.07, p = n.s). Patients with an ABI < 0.9 had lower fetuin A levels than patients with an ABI 0.9-1.3 or > 1.3 (0.43 ± 0.10 vs. 0.52 ± 0.17 vs. 0.54 ± 0.18 g/L p = 0.05). Neither GFR nor albuminuria were associated with fetuin-A serum levels. Patients with prevalent neuropathy did not have altered fetuin-A levels compared to diabetic controls. In step-wise logistic regression analysis including age, gender, HbA1c, total cholesterol, glomerular filtration rate and fetuin-A, only total cholesterol (β = 0.01, p = 0.02) and fetuin-A (β = -5.99, p = 0.03) proved to be independent predictors of an ABI < 0.9.
  
  
  CONCLUSIONS
  The results of this cross-sectional study suggest that lower fetuin-A levels are associated with macrovascular late complications in high-risk type 2 diabetes patients while there are no associations of fetuin-A with metabolic status or microvascular complications.
authors.affiliation: Department of Nephrology, Klinikum rechts der Isar, Munich, Germany. marcel.roos@lrz.tum.de
authors.forename: Marcel
authors.initials: M
authors.lastname: Roos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Oikonomou
authors.forename: Maximilian
authors.initials: M
authors.lastname: von Eynatten
authors.forename: Peter B
authors.initials: PB
authors.lastname: Luppa
authors.forename: Uwe
authors.initials: U
authors.lastname: Heemann
authors.forename: Jens
authors.initials: J
authors.lastname: Lutz
authors.forename: Marcus
authors.initials: M
authors.lastname: Baumann
authors.forename: Peter P
authors.initials: PP
authors.lastname: Nawroth
authors.forename: Angelika
authors.initials: A
authors.lastname: Bierhaus
authors.forename: Per M
authors.initials: PM
authors.lastname: Humpert
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000378:metabolism*; D001798:Blood Proteins / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D060749:alpha-2-HS-Glycoprotein
chemical_list: C556354:AHSG protein, human; D015415:Biomarkers; D001798:Blood Proteins; D060749:alpha-2-HS-Glycoprotein
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