Background: Osteoprotegerin (OPG) is a member of tumor necrosis factor superfamily, belonging to the class of inhibitors of osteoclastogenesis. An association between the concentration of OPG, the risk of stroke, ischemic heart disease, stable angina, as well as the severity of coronary atherosclerosis, as measured by the total value of the latter and the severity of coronary calcification was found. OPG is likely to have an acceptable predictive value with respect to the onset of death in long-term observation of patients with coronary heart disease, type 2 diabetes, ischemic stroke, hypertension, and in patients with chronic renal failure.
Purpose: to evaluate the interrelation between circulating OPG and coronary vasculature damage in type 2 diabetes mellitus patients with known coronary artery disease.
Methods: 126 subjects with stable diabetes mellitus 2 type with previously angiographic documented CAD were enrolled to the study. All patients were graduated into two groups depended calculating very high risk cardiovascular events and other. Assessment of risk was performed with contrast multispiral CT- angiography. Patients with Agatston' coronary calcium score (CCS) ≥ 320 units were stratified as high risk (n = 72) and all other patients as low risk patients (n = 54). OPG plasma levels were measured with ELISA.
Results: Analysis of the results showed that in a cohort of patients examined the mediana of circulating OPG was 3849.51 pg/mL (95% CI = 3282.23-4413.79 pg/mL). Circulating OPG level in high risk subjects was significantly higher when compared with low risk patients (5295.86 pg/mL [95% confidence interval (CI) = 4856.90-5734.82 pg/mL] and 2230.85 pg/mL; 95% CI = 1860.57-2801.13 pg/mL; P<0.001). We suggested that patients in the highest quartile had a significantly higher risk of vascular atherosclerosis damage compared with those in the first quartile (OR=5.16; 95% CI=1.15-9.68; P=0.001). The findings suggest that the predictive power of the model for high-risk patients, the estimated largest AUC (area under curve), somewhat higher than for patients with relatively low risk (AUC = 0,685 and AUC = 0,670, respectively). In this case, the split point for the concentration of OPG, have the best prognostic potential on the risk of coronary atherosclerosis, were for both groups of patients, 4551.3 pg / ml and 3229.8 pg / ml, respectively.
Conclusion: It was found that elevated OPG in plasma can be considered as independent predictor of severity of coronary vasculature damage in type 2 diabetic patients.