osteoprotegerin and Coronary-Stenosis

Osteoprotegerin (OPG) is a member of the tumor necrosis factor superfamily.Recent evidence supports a relationship between serum OPG level and atherosclerosis. The aim of this study was to evaluate the possible association of OPG with the presence of coronary artery disease (CAD), its severity and prognosis in patients with chest pain and suspected coronary stenosis.. In this cross-sectional analytic study, 180 candidates of elective coronary artery angiography were recruited. Serum level of OPG was measured by ELISA method in all patients and its relation with presence and severity of CAD based on a coronary atherosclerosis score (CAS) was assessed. Patients were followed for a mean period of about 24 ± 3.2 months and the relationship between OPG levels and future cardiac events were evaluated.. The mean serum level of OPG was 1637 ± 226 pg/mL in those with CAD and 1295 ± 185 pg/mL (nonparametric p = 0.001) in those without it. There was a significant direct correlation between the level of serum OPG and CAS (rho = 0.225, p = 0.002). The optimalcut-off point for predicting a significant coronary artery obstruction was a serum level of≥ 1412 pg/mL with a sensitivity and specificity of 60% and 57.8%, respectively. Major adversecardiac events (MACE) including cardiovascular death, admission with acute coronary syndrome,or heart failure, was significantly higher in those with higher OPG levels (22 [34.3%]vs. 15 [16%], p = 0.012).. There was a direct and significant correlation between the serum level of OPG and CAS. MACE occurred more commonly in those with higher baseline OPG levels.

Topics: Acute Coronary Syndrome; Adult; Aged; Angina Pectoris; Biomarkers; Coronary Angiography; Coronary Artery Disease; Coronary Stenosis; Cross-Sectional Studies; Enzyme-Linked Immunosorbent Assay; Female; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Osteoprotegerin; Predictive Value of Tests; Prognosis; Risk Factors; Severity of Illness Index; Time Factors; Up-Regulation

Osteoprotegerin (OPG) is a member of the tumor necrosis factor superfamily and plays an important regulatory role in the skeletal, immune, and vascular systems. Intermediate coronary artery lesions that have a diameter stenosis of approximately 20%-70% might cause serious consequences. However, the prognostic value of plasma OPG levels in patients with intermediate coronary artery lesions has been less reported.. We hypothesized that OPG is a predictive marker of prognosis of intermediate coronary artery lesions.. A prospective study was performed on 890 patients with intermediate (20%-70%) coronary lesions. The median age was 62 years (25th and 75th percentiles, 55 and 70 years, respectively) and 67.2% were male. Fasting blood was sampled at baseline. The primary clinical endpoint was a composite of readmission due to angina pectoris, nonfatal myocardial infarction, revascularization, and cardiovascular death.. During a median follow-up of 24 months, events occurred in 11.1% of the patients. Of these patients, 7.9% were readmitted for angina pectoris, 1.5% received revascularization, 0.7% suffered nonfatal myocardial infarction, and 1.0% died. The plasma levels of OPG (median, 5304.7 pg/mL vs 2993.4 pg/mL, P<0.001) and high-sensitivity C-reactive protein (median, 4.8 mg/L vs 2.6 mg/L, P<0.001) were higher in patients with events than those without events. After adjusting for traditional risk factors such as age, gender, smoking, hypertension, diabetes, dyslipidemia, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, percent area stenosis, and drug administration, a multivariate Cox proportional hazard analysis showed that higher OPG levels were an independent predictive factor of the composite clinical endpoint (hazard ratio: 2.49, 95% confidence interval: 1.26-4.89, fourth quartile vs first quartile).. The higher level of OPG is an independent predictive factor of prognosis in patients with intermediate coronary lesions.

Topics: Aged; Biomarkers; Chi-Square Distribution; China; Coronary Angiography; Coronary Stenosis; Female; Humans; Male; Middle Aged; Osteoprotegerin; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Survival Analysis; Time Factors; Up-Regulation

Coronary artery calcification (CAC) is thought to be associated with greater cardiovascular mortality in patients with end-stage renal disease than in nonuremic persons. The purpose of the present study is to assess the effects of etidronate, a synthetic analogue of pyrophosphate, on progression of CAC score.. The extent of CAC was evaluated by using multidetector spiral computed tomography. Repeated CAC score estimation was possible in 35 patients (29 men, 6 women). Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Serum osteoprotegerin (OPG) was measured by using enzyme-linked immunoassay. Serum etidronate was measured by means of the gas spectrometry technique using deuterium-labeled etidronate as internal standard.. Mean patient age was 63.2 +/- 8.2 (SD) years, and mean duration of dialysis therapy was 7.4 +/- 5.5 years. CAC score was estimated 3 times in each patient. After the second CAC score estimation, 35 patients were administered etidronate, 200 mg/d, for 14 days. This cycle was repeated 3 times every 90 days. CAC progression was significantly less pronounced during treatment with etidronate compared with the period before treatment was initiated. The median annualized absolute increase in calcified volume was 195.0 mm3 without treatment compared with -490.0 mm3 during treatment ( P < 0.01). Patients were divided into 2 groups based on changes in CAC score during etidronate treatment. Responders (n = 26) were patients whose CAC score decreased during therapy, and nonresponders (n = 9) were patients whose CAC score increased, even after etidronate therapy. Serum C-reactive protein values (0.18 +/- 0.13 mg/dL) in the responder group were greater than those (0.14 +/- 0.08 mg/dL) in the nonresponder group ( P = 0.013). Serum OPG levels decreased significantly during etidronate therapy (256.8 +/- 93.8 versus 245.0 +/- 83.0 pg/mL; P = 0.0161). Etidronate was well tolerated during the study. BMD values during etidronate therapy were not significantly changed from 0.941 +/- 0.125 to 0.968 +/- 0.246 g/cm2.. Results of the present study suggest that the extent of CAC may be suppressed by etidronate in association with a reduction in chronic inflammatory responses. They also suggest that a decrease in serum OPG concentrations by means of etidronate may be associated with changes in vascular calcification in dialysis patients.

Topics: Aged; Blood Chemical Analysis; Bone Density; Coronary Stenosis; Etidronic Acid; Female; Glycoproteins; Humans; Kidney Failure, Chronic; Male; Middle Aged; Osteoprotegerin; Receptors, Cytoplasmic and Nuclear; Receptors, Tumor Necrosis Factor; Renal Dialysis; Tomography, Spiral Computed