Inactive matrix gla protein is causally related to adverse health outcomes: A mendelian randomization study in a flemish population

Yan Ping Liu, Yu Mei Gu, Lutgarde Thijs, Marjo H J Knapen, Erika Salvi, Lorena Citterio, Thibault Petit, Simona Delli Carpini, Zhenyu Zhang, Lotte Jacobs, Yu Jin, Cristina Barlassina, Paolo Manunta, Tatiana Kuznetsova, Peter Verhamme, Harry A. Struijker-Boudier, Daniele Cusi, Cees Vermeer, Jan A. Staessen

Research output: Contribution to journalArticlepeer-review


Matrix Gla-protein is a vitamin K-dependent protein that strongly inhibits arterial calcification. Vitamin K deficiency leads to production of inactive nonphosphorylated and uncarboxylated matrix Gla protein (dp-ucMGP). The risk associated with dp-ucMGP in the population is unknown. In a Flemish population study, we measured circulating dp-ucMGP at baseline (1996-2011), genotyped MGP, recorded adverse health outcomes until December 31, 2012, and assessed the multivariable-adjusted associations of adverse health outcomes with dp-ucMGP. We applied a Mendelian randomization analysis using MGP genotypes as instrumental variables. Among 2318 participants, baseline dp-ucMGP averaged 3.61 μg/L. Over 14.1 years (median), 197 deaths occurred, 58 from cancer and 70 from cardiovascular disease; 85 participants experienced a coronary event. The risk of death and non-cancer mortality curvilinearly increased (P≤0.008) by 15.0% (95% confidence interval, 6.9-25.3) and by 21.5% (11.1-32.9) for a doubling of the nadir (1.43 and 0.97 μg/L, respectively). With higher dp-ucMGP, cardiovascular mortality log-linearly increased (hazard ratio for dp-ucMGP doubling, 1.14 [1.01-1.28]; P=0.027), but coronary events log-linearly decreased (0.93 [0.88-0.99]; P=0.021). dp-ucMGP levels were associated (P≤0.001) with MGP variants rs2098435, rs4236, and rs2430692. For non-cancer mortality and coronary events (P≤0.022), but not for total and cardiovascular mortality (P0.13), the Mendelian randomization analysis suggested causality. Higher dp-ucMGP predicts total, non-cancer and cardiovascular mortality, but lower coronary risk. For non-cancer mortality and coronary events, these associations are likely causal.

Original languageEnglish
Pages (from-to)463-470
Number of pages8
Issue number2
Publication statusPublished - Feb 21 2015


  • matrix Gla protein
  • Mendelian randomization
  • mortality

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)


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