title: The association of fetuin-A with cardiovascular disease mortality in older community-dwelling adults: the Rancho Bernardo study.
abstract: OBJECTIVE
  The goal of this study was to evaluate the prospective association of fetuin-A levels with cardiovascular disease (CVD) mortality.
  
  
  BACKGROUND
  Fetuin-A is a circulating inhibitor of calcium deposition in the vasculature and of insulin action in muscle and fat, and may be involved in the pathogenesis of CVD.
  
  
  METHODS
  This is a population-based prospective study of 633 men and 1,025 women (median age = 73 years) who had fetuin-A levels and CVD risk factors evaluated in 1992 to 1996 and were followed for vital status through 2010.
  
  
  RESULTS
  Plasma fetuin-A (g/l ± SD) was highest in women using oral estrogens (0.55 ± 0.12), intermediate for women not using oral estrogens (0.51 ± 0.10), and lowest for men (0.50 ± 0.10), p < 0.001. Lower fetuin-A levels were associated with older age, but with lower levels of other CVD risk factors including adiposity, blood pressure, lipids, triglycerides, and insulin resistance (all p < 0.01). During the median 12-year follow-up, 273 deaths were attributed to CVD. The association of fetuin-A with CVD mortality differed by diabetes status (p for interaction = 0.003). Adjusting for age, sex, oral estrogens, and lifestyle, the hazard ratio for CVD mortality comparing the lowest fetuin-A quartile with all higher values was 1.76 (95% confidence interval [CI]: 1.34 to 2.31; p < 0.001) for participants without diabetes and 0.43 (95% CI: 0.19 to 0.98; p = 0.046) for participants with diabetes.
  
  
  CONCLUSIONS
  Low fetuin-A levels predicted greater risk for CVD mortality in older adults without diabetes, but were associated with reduced risk of CVD death in those with diabetes. Fetuin-A may provide novel insight into mechanisms leading to CVD death in those with versus without diabetes.
authors.affiliation: Division of Epidemiology, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California 92093, USA. glaughlin@ucsd.edu
authors.forename: Gail A
authors.initials: GA
authors.lastname: Laughlin
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Cummins
authors.forename: Christina L
authors.initials: CL
authors.lastname: Wassel
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ix
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D048909:Diabetes Complications / Q000097:blood / Q000401:mortality; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D060749:alpha-2-HS-Glycoprotein / Q000096:biosynthesis*
chemical_list: D060749:alpha-2-HS-Glycoprotein