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Associations of Fibroblast Growth Factor 23 and Fetuin-A With Coronary Plaque Burden and Plaque Composition in Young Adults
  1. Fatih Akin, MD*,
  2. Omer Celik, MD,
  3. Burak Ayca, MD,
  4. Ibrahim Altun, MD*,
  5. Vesile Ornek Diker, MD†§,
  6. Ismail Bıyık, MD,
  7. Dimitrie Siriopol, MD║,
  8. Adrian Covic, MD║,
  9. Mehmet Kanbay, MD
  1. From the *Department of Cardiology, Muğla Sıtkı Kocman University School of Medicine, Muğla; †Department of Cardiology, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital; and ‡Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul; and §Department of Biochemistry, Mehmet Akif Ersoy Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey; ║Nephrology Clinic, Dialysis and Renal Transplant Center, G. I. Popa University Hospital of Medicine and Pharmacy, Iasi, Romania; and ¶Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.
  1. Received October 9, 2014, and in revised form December 13, 2014.
  2. Accepted for publication January 1, 2015.
  3. Reprints: Fatih Akın, MD, Orhaniye Mah, Merkez, 48000, Muğla Sıtkı Kocman University School of Medicine, Muğla, Turkey. E-mail: faith._akin{at}, fatihakin{at}
  4. The authors have no conflicts of interest to declare.


Objective The total burden of subclinical coronary artery disease (CAD) is significant among young adults. Serum fibroblast growth factor 23 (FGF-23) and fetuin-A are established predictors of morbidity and mortality because of cardiovascular disease. The objective of the study was to evaluate the relationship between subclinical CAD and serum FGF-23 and fetuin-A concentrations among a population of young adults.

Methods A total of 241 subjects younger than 45 years who had undergone coronary computed tomographic angiography (CCTA) were included in the study. In 117 patients, the CCTA detected subclinical CAD; the rest of the patients had no CAD detected on CCTA.

Results Serum FGF-23 and fetuin-A levels were significantly increased in the CAD patients as compared with the non-CAD patients (26.7 [interquartile range, 22.4-31.9] vs 15.7 [interquartile range, 13.2-18.1] pg/mL and 904.7 [interquartile range, 695.5-1021.6] vs 469.6 [331.4-660.5] mg/L, respectively; P < 0.001 for both). Furthermore, a positive correlation was identified between FGF-23 and fetuin-A levels and the total number of plaques (r = 0.21 and r = 0.28, respectively; P < 0.001 for both). In multivariate logistic regression analysis, age, smoking status, uric acid, FGF-23, and fetuin-A levels were found to be independently associated with the presence of CAD.

Conclusions The presence of subclinical CAD is independently associated with FGF-23 and fetuin-A and could be used as novel risk markers of cardiovascular disease in the asymptomatic young adult population.

Key Words
  • fibroblast growth factor 23
  • fetuin-A
  • subclinical atherosclerosis
  • coronary computed tomography angiography

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