title: Usefulness of fetuin-A to predict risk for cardiovascular disease among patients with obstructive sleep apnea.
abstract: Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular diseases (CVDs). Fetuin-A, a novel hepatokine, has been associated with the metabolic syndrome (MetS), insulin resistance, and type 2 diabetes mellitus, all of which are highly prevalent in patients with OSA and associated with increased CVD risk. The goal of this study was to determine whether fetuin-A could be involved in the pathogenesis of CVD risk in patients with OSA, through relations of fetuin-A with MetS components and/or insulin resistance. Overweight or obese, nondiabetic volunteers (n = 120) were diagnosed with OSA by in-laboratory nocturnal polysomnography. Steady-state plasma glucose concentrations derived during the insulin suppression test were used to quantify insulin-mediated glucose uptake; higher steady-state plasma glucose concentrations indicated greater insulin resistance. Fasting plasma fetuin-A and lipoprotein concentrations were measured. Whereas neither the prevalence of MetS nor the number of MetS components was associated with tertiles of fetuin-A concentrations, the lipoprotein components of MetS, triglycerides and high-density lipoprotein cholesterol, increased (p <0.01) and decreased (p <0.05), respectively, across fetuin-A tertiles. Additionally, comprehensive lipoprotein analysis revealed that very low density lipoprotein (VLDL) particles and VLDL subfractions (VLDL1+2 and VLDL3) were increased across fetuin-A tertiles. In contrast, neither insulin resistance nor sleep measurements related to OSA were found to be modified by fetuin-A concentrations. In conclusion, abnormalities of lipoprotein metabolism, but not MetS or insulin resistance per se, may represent a mechanism by which fetuin-A contributes to increased CVD risk in patients with OSA.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: aliceliu@stanford.edu.
authors.forename: Alice
authors.initials: A
authors.lastname: Liu
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Cindy
authors.initials: C
authors.lastname: Lamendola
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Danit
authors.initials: D
authors.lastname: Ariel
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Fahim
authors.initials: F
authors.lastname: Abbasi
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Sun H
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: James
authors.initials: J
authors.lastname: Cardell
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Tomasso
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Shiming
authors.initials: S
authors.lastname: Xu
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Shailja
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Hafasa
authors.initials: H
authors.lastname: Mojaddidi
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Kaylene
authors.initials: K
authors.lastname: Grove
authors.affiliation: Stanford Sleep Medicine Center, Stanford University School of Medicine, Stanford, California.
authors.forename: Clete A
authors.initials: CA
authors.lastname: Kushida
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Reaven
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002140:California / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000150:complications*; D060749:alpha-2-HS-Glycoprotein / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D060749:alpha-2-HS-Glycoprotein