title: Fetuin-A, type 2 diabetes, and risk of cardiovascular disease in older adults: the cardiovascular health study.
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.
  
  
  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% 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.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. mkjensen@hsph.harvard.edu
authors.forename: Majken K
authors.initials: MK
authors.lastname: Jensen
authors.forename: Traci M
authors.initials: TM
authors.lastname: Bartz
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.forename: Luc
authors.initials: L
authors.lastname: Djoussé
authors.forename: Jorge R
authors.initials: JR
authors.lastname: Kizer
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Zieman
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.forename: Michael
authors.initials: M
authors.lastname: Shlipak
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ix
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism*; D005260:Female; D060748:Fetuins / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors
chemical_list: D060748:Fetuins