Original Full Length ArticleSerum fetuin-A levels and abdominal aortic calcification in healthy men - The STRAMBO study

- In men aged ≥ 40 years, lower serum fetuin-A was associated with severe abdominal aortic calcification (AAC) after adjustment for confounders.
- Coexistence of low serum fetuin-A and hypertension, heavy smoking, high FGF23 or low Dickkopf-1 levels were associated with severe AAC.
- Similar results were obtained for 789 men with glomerular filtration rate > 60 mL/min/1.73 m2.

Vascular calcification results from an imbalance between increased extracellular levels of calcium and phosphate, reduced solubility, and low levels of calcification inhibitors in blood or the vascular wall. Fetuin-A is a major circulating calcification inhibitor. Rodent models of fetuin-A deficit indicate its calcification inhibiting potential. Clinical studies suggest its role as a biomarker in vascular disease. This cross-sectional study was performed in a cohort of 974 men aged ≥ 40 years (average 68 years) consisting of men holding health insurance cover with Mutuelle des Travailleurs de la Région Lyonnaise. Abdominal aortic calcification (AAC) was assessed semi-quantitatively on lateral dual energy X-ray absorptiometry (DXA) spine scans. Serum fetuin-A was measured by an immunoassay. After adjustment for confounders (age, lifestyle, body composition, health status, treatment, glomerular filtration rate [GFR], hormones, and cytokines), prevalence of severe AAC (AAC score > 4) decreased with increasing fetuin-A levels (OR = 0.68 per SD increase, 95% CI: 0.54-0.84, p < 0.001). After adjustment for confounders, low fetuin-A and hypertension were each associated with higher odds of AAC > 4. Coexistence of low serum fetuin-A levels and heavy smoking, elevated fibroblast growth factor 23 levels or low serum dickkopf-1 levels were associated with higher odds of AAC > 4. Similar results were obtained for 789 men with GFR > 60 mL/min/1.73 m2. Similar results were obtained when severe AAC was defined as AAC score > 3 or AAC > 5.Thus, lower serum fetuin-A levels are associated with severe AAC, suggesting that poor calcification inhibitory potential contributes to vascular calcification, independently of renal impairment.