Serum osteoprotegerin and carotid intima–media thickness in acute/chronic coronary artery diseases

Cardiovascular Biomarkers: Lessons of the Past and Prospects for the Future

Cardiovascular diseases (CVDs) are a major healthcare burden on the population worldwide. Early detection of this disease is important in prevention and treatment to minimise morbidity and mortality. Biomarkers are a critical tool to either diagnose, screen, or provide prognostic information for pathological conditions. This review discusses the historical cardiac biomarkers used to detect these conditions, discussing their application and their limitations. Identification of new biomarkers have since replaced these and are now in use in routine clinical practice, but still do not detect all disease. Future cardiac biomarkers are showing promise in early studies, but further studies are required to show their value in improving detection of CVD above the current biomarkers. Additionally, the analytical platforms that would allow them to be adopted in healthcare are yet to be established. There is also the need to identify whether these biomarkers can be used for diagnostic, prognostic, or screening purposes, which will impact their implementation in routine clinical practice.

The role of serum osteoprotegerin level in diagnosis of disease and determining cardiovascular risk of polycystic ovary syndrome

Objective: Although animal studies claim that osteoprotegerin (OPG) is preventive on this system, there are conflicting results in human studies. The aim of this study was to investigate the role of OPG in the diagnosis and determination of cardivovascular risk in patients with polycystic ovary syndrome (PCOS), which is a multisystem effective disease.Method: The study was performed on 28 premenopausal healthy female volunteers and 57 newly diagnosed PCOS patients in 2017. Anamnesis was obtained, body mass indexes were calculated, laboratory tests required for diagnosis and differential diagnosis of PCOS and suprapubic ovarian ultrasonography were performed, serum OPG level was studied by enzyme-linked immunosorbent assay.Results: OPG levels were similar in PCOS and control groups and there was no significant difference (49.392 ± 10.973 pg/ml vs 49.567 ± 13.57 pg/ml, p = .815). Correlation analysis showed a positive correlation between OPG and total testosterone levels in the PCOS group (r = 0.277, p = .045). No significant relationship with cardiovascular and metabolic parameters was detected.Conclusion: No difference was found between PCOS patients and control groups in terms of OPG levels. Therefore, it is thought that OPG level cannot be used in the diagnosis of the disease. There was no significant relationship between cardiometabolic parameters.

Genetic Variants and Haplotypes in OPG Gene Are Associated with Premature Coronary Artery Disease and Traditional Cardiovascular Risk Factors in Mexican Population: The GEA Study

Basic and clinical research have demonstrated that osteoprotegerin (OPG) plays an important role in the development and progression of cardiovascular diseases. The aim of this study was to evaluate the association of four polymorphic sites (rs2073618, rs3134069, rs3134070, and rs3102735) of OPG gene with premature coronary artery disease (pCAD), and with cardiometabolic parameters. The polymorphisms were genotyped using 5' exonuclease TaqMan genotyping assays with real-time PCR in 1098 individuals with pCAD and 1041 healthy controls. rs2073618 polymorphism was associated with a high risk of developing pCAD according to different inheritance models: additive (p = 0.001; odds ratio [OR] = 1.283), dominant (p = 0.006; OR = 1.383), recessive (p = 0.011; OR = 1.423), and codominant 2 (p = 0.001; OR = 1.646). The four polymorphisms were associated with different cardiovascular risk factors in individuals with pCAD and controls. Our results suggest that OPG rs2073618 polymorphism is associated with an increased risk of pCAD. In addition, two haplotypes were associated with pCAD, one increasing the risk (CACT) and another one as protective (GACC).

Prognostic value of carotid intima-media in the short- and long-term mortality in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study

BACKGROUND AND AIMS

Atherosclerotic in carotids can determinate a poor prognosis in individuals after acute coronary syndrome (ACS). Thus, we aimed to evaluate mortality associated to carotid intima media thickness (CIMT) in the participants from the Strategy of Registry of Acute Coronary Syndrome (ERICO) study.

METHODS

Carotid intima media thickness was evaluated by B-mode ultrasound for mortality risk assessment in 180 days, 1-3 years. We performed Kaplan-Meier survival curves and Cox logistic regression models to evaluate all-cause, cardiovascular (CVD) and coronary heart disease (CHD) mortality by CIMT tertiles in crude, age and sex- and multivariate models.

RESULTS

Among 644 ACS individuals (median age 61-year old), we observed a median CIMT of 0.74 mm. Besides aging, low education, hypertension, diabetes, and dyslipidemia were associated with the 3rd tertile of CIMT values. During 3 years of follow-up, we observed 65 deaths (10.1%), crude case-fatality rates were progressively higher across the CIMT tertiles in all periods, being the highest rates observed in participants with the highest CIMT (3rd tertile) (180-day: 6.6% vs 1-year: 9.0% vs 2-year:12.3% vs 3-year:16.0%, P < .05). In crude analyses, lowest survival rates (all-cause, CVD and CHD, p log-rank values <0.005) and higher hazard ratios of dying for all-cause and CVD (from 1 to 3 years) and for CHD (2 and 3 years) were observed. However, we kept no significant results after adjusting for age.

CONCLUSION

Carotid intima media thickness was mainly influenced by aging. CIMT was not a good predictor of all-cause, CVD or CHD mortality in the ERICO study.

Osteoprotegerin levels are associated with liver fat and liver markers in dysmetabolic adults

AIM

This study aimed to determine the association between visceral adipose tissue (VAT), liver fat (LF) content, and other markers of the metabolic syndrome (MetS) and osteoprotegerin (OPG) in dysmetabolic adults.

METHODS

Subjects from the NUMEVOX cohort were included if they fulfilled at least one MetS criterion. They then underwent a thorough metabolic and cardiovascular evaluation, including arterial stiffness, atherosclerotic plaques, homoeostasis model assessment for insulin resistance (HOMA-IR) indices and OPG. VAT and LF content were measured by magnetic resonance imaging (MRI). Ultrasound examination of arteries and arterial stiffness were recorded, and age- and gender-adjusted paired correlations calculated.

RESULTS

Body mass index, waist circumference and MRI-derived VAT correlated with OPG, whereas abdominal subcutaneous fat did not. OPG levels were strongly correlated with LF content (r=0.25, P=0.003), liver markers such as alanine aminotransferase (r=0.39, P<0.001) and HOMA-IR index (r=0.39, P<0.0001). Plasma OPG also correlated with arterial stiffness and the number of atherosclerotic sites.

CONCLUSION

Plasma OPG levels are positively associated with both liver markers and increased LF content, but not with subcutaneous fat in dysmetabolic men. These findings suggest that elevated OPG levels may play a role in the link between fatty liver disease and enhanced cardiovascular risk.

Stenosis level, plaque morphology and intima-media thickness of internal carotid artery in chronic stable angina and acute coronary syndrome; a comparative study

Background:

Ischemic heart disease (IHD) is the most common cause of cardiovascular diseases and divided into two main categories as acute coronary syndrome (ACS) and chronic stable angina (CSA). These two groups have stenosis and atherosclerosis in the coronary artery, but are more severe in patients with ACS.

Objectives:

We aimed to find the association between coroner and internal carotid artery, also comparing prospectively stenosis level, plaque morphology and intima-media thickness of internal carotid between patients with acute coronary syndrome (ACS) and chronic stable angina.

Patients and Methods:

In this study, 60 patients were enrolled as ACS group chosen from those admitted in CCU or referred to clinic. Forty-five patients of CSA group were chosen from those referred to clinic. All 105 patients underwent color Doppler sonography, and stenosis, plaque morphology and intima media thickness (IMT) were measured.

Results:

In 60 patients with ACS, 49 (81.7%) had no stenosis in ultrasonography and 11 (18.3%) had some degrees of stenosis; also 28 (46.7%) and 16 (26.7%) of patients had plaque and IMT, respectively. In the rest 45 patients of CSA group, just 4 (8.9%), 17 (37.8%) and 8 (17.8%) patients had stenosis, plaque and IMT, respectively. Therefore, there was no statistically significant difference between the two groups regarding stenosis (P = 0.171), plaque morphology (P = 0.362) and IMT (P = 0.283) (Power = 90%).

Conclusions:

According to the results, there were no significant and meaningful differences comparing ACS and CSA groups of patients by ECDS using three indicators of stenosis, plaque morphology and IMT as indicators of atherosclerosis. Results also display that patients with ACS had more stenosis, more plaque and thicker intima–media, but these differences were not statistically significant (P < 0.05).

Association of circulating sclerostin with vascular calcification in Afro-Caribbean men

OBJECTIVE

Sclerostin, a Wingless (Wnt) pathway antagonist, is an established regulator of bone mineralization in humans but its potential importance in the regulation of vascular calcification is less clear. Therefore, our objective was to assess the relationship of serum sclerostin levels with coronary and aortic artery calcification (CAC and AAC, respectively) in Afro-Caribbean men on the island of Tobago.

METHODS

Serum sclerostin levels and computed tomography of CAC and AAC were measured in 191 men (age mean(SD): 62.9(8.0)years) recruited without regard to health status. Multivariable logistic regression models were used to assess the cross-sectional association of sclerostin with prevalent arterial calcification.

RESULTS

Mean(SD) sclerostin was 45.2 pmol/L (15.6 pmol/L). After adjusting for risk factors including age, physical and lifestyle characteristics, comorbidities, lipoproteins and kidney function, 1 SD greater sclerostin level was associated with a 1.61-times (95%CI 1.02-2.53) greater odds of having CAC. Sclerostin was not associated with AAC in any model.

CONCLUSIONS

This is the first study to show that, among Afro-Caribbean men, greater serum sclerostin concentrations were associated with prevalence and extent of CAC. Further studies are needed to better define the role of the Wnt signaling pathway in arterial calcification in humans.

Role of osteoprotegerin in vascular disorders of the end-stage renal disease patients

AIM

To assess the osteoprotegerin (OPG) relationship with cardiovascular complications in hemodialysis (HD) patients.

METHODS

The study included 87 HD patients. Clinical characteristics, ankle-arm index (AAI), OPG and mineral markers levels were recorded. Arterial intimal calcification (AIC) and arterial medial calcification (AMC) were registered.

RESULTS

OPG levels were increased in HD patients. Patients with AIC (p = 0.006)/ AMC (p = 0.01) had higher OPG levels. OPG did not have any relation with cardiovascular diseases. OPG correlated positively with age, increased HD vintage and inversely with albumin and AAI. OPG has not been a risk factor for VC or cardiovascular disease.

CONCLUSION

OPG rising could be a reaction in defense to vascular aggression, because OPG was associated with VC, but not with vascular disease.

Role of osteoprotegerin gene variants in early-onset severe pre-eclampsia

AIM

The aim of this study was to detect the role of osteoprotegerin (OPG) gene variants in early-onset severe pre-eclampsia.

MATERIAL AND METHODS

The associations of 163A/G (rs3102735) and 950T/C (rs2073617) polymorphisms of OPG with pre-eclampsia (60 cases of early-onset severe pre-eclampsia and 91 cases of late-onset pre-eclampsia), as well as with the clinical manifestations of individuals, were evaluated.

RESULTS

Data showed lower frequencies of TC and TC + CC genotypes and C allele of 950T/C in the early-onset group than those of the control and late-onset groups (P = 0.003; P = 0.002; P = 0.005; P = 0.031; P = 0.021; P = 0.022). However, no significant differences were found in genotype and allele frequencies between the late-onset and control groups. Moreover, no significant differences were observed in the genotype and allele frequencies of 163A/G polymorphism among the three groups. In the early-onset group, 950T/C TC + CC genotype carriers exhibited significantly lower systolic blood pressure ([147.25 ± 11.89] mmHg) and 24-h urine protein ([2.46 ± 0.92] g) than the TT carriers ([165.88 ± 20.39] mmHg, [3.64 ± 0.81] g) (P = 0.003; P = 0.001, respectively). Serum creatinine was significantly higher in women with the 163A/G AG + GG genotypes ([82.31 ± 11.66] μmol/L) than in those with the AA genotype ([71.90 ± 16.85] μmol/L) (P = 0.003).

CONCLUSION

This study implicates that OPG gene variants may be associated with early-onset severe pre-eclampsia.

Changes of plasma concentration of osteoprotegerin and its association with endothelial dysfunction before and after hypouricemic therapy in patients with hyperuricemia

OBJECTIVE

Osteoprotegerin (OPG) is a secreted glycoprotein in the regulation of bone turnover. Recently, many studies showed that OPG acts as an important regulatory molecule in the vascular systems. Our objective was to examine the plasma OPG levels alteration and its association with endothelial function before and after hypouricemic therapy in patients with hyperuricemia.

METHODS

Thirty patients (28 males and 2 females, serum uric acid > 7.0 mg/dl) with hyperuricemia were selected. Thirty healthy individuals (28 males and 2 females) with normal serum uric acid were also selected as control. Patients were administered with hypouricemic therapy for 6 months. Plasma OPG concentration was measured in duplicate using a sandwich ELISA and high-resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia and after sublingual glyceryltrinitrate.

RESULTS

Plasma OPG levels in patients with hyperuricemia before hypouricemic therapy was significantly higher than those in controls (3.39 ± 0.25 vs. 2.05 ± 0.74 ng/L, p < 0.01). After hypouricemic therapy, OPG levels decreased markedly (2.54 ± 0.38 ng/L, p < 0.01). Flow-mediated dilation (FMD) in patients with hyperuricemia was 3.07 ± 1. 23%, which was significantly lower than that in control subjects (4.62 ± 0.69%, p < 0.01), and it improved significantly after hypouricemic therapy (3.91 ± 1.37%, p < 0.01). The absolute changes in OPG showed a significant positive correlation with the changes in serum uric acid (p < 0.05) and negative correlation with the changes in FMD (p < 0.01) in patients with hyperuricemia during the course of hypouricemic therapy.

CONCLUSION

The current study demonstrates that plasma OPG levels increased significantly in patients with hyperuricemia and decreased significantly after hypouricemic therapy, and are correlated with FMD. These findings support the growing concept that elevated plasma OPG levels may be involved with the development of endothelial dysfunction in patients with hyperuricemia.

A novel cardiac bio-marker: ST2: a review

Cardiovascular diseases (CVD) are the major cause of death worldwide. The identification of markers able to detect the early stages of such diseases and/or their progression is fundamental in order to adopt the best actions in order to reduce the worsening of clinical condition. Brain natriuretic peptide (BNP) and NT-proBNP are the best known markers of heart failure (HF), while troponins ameliorated the diagnosis of acute and chronic coronary artery diseases. Nevertheless, many limitations reduce their accuracy. Physicians have tried to develop further detectable molecules in order to improve the detection of the early moments of CVD and prevent their development. Soluble ST2 (suppression of tumorigenicity 2) is a blood protein confirmed to act as a decoy receptor for interleukin-33. It seems to be markedly induced in mechanically overloaded cardiac myocytes. Thus, HF onset or worsening of a previous chronic HF status, myocardial infarct able to induce scars that make the myocardium unable to stretch well, etc, are all conditions that could be detected by measuring blood levels of soluble ST2. The aim of this review is to explore the possible role of ST2 derived-protein as an early marker of cardiovascular diseases, above all in heart failure and ischemic heart diseases.

Associations of fetuin-A and osteoprotegerin with arterial stiffness and early atherosclerosis in chronic hemodialysis patients

BACKGROUND

Cardiovascular morbidity and mortality remains excessive in patients with chronic kidney disease. The association of vascular changes with regulators of extraosseous calcification in this patient population is still under investigation. The aim of the present study was to investigate the associations of the calcification inhibitor fetuin-A, and the anti-osteoclastic factor osteoprotegerin (OPG) with vascular pathology in chronic hemodialysis patients.

METHODS

In this cross-sectional study including 81 stable chronic hemodialysis patients, we measured carotid-to-femoral pulse wave velocity (cfPWV) with applanation tonometry, reflecting arterial stiffness, and common carotid intima-media thickness (ccIMT), a surrogate of early atherosclerosis, as well as serum levels of fetuin-A and OPG. Co-morbidities, traditional cardiovascular risk factors, inflammatory markers and mineral-bone disease serology parameters were also recorded.

RESULTS

cfPWV correlated inversely with fetuin-A (r=-0.355, p=0.001) and positively with OPG (r=0.584, p<0.001). In multilinear regression analysis including age, gender, diabetes, cardiovascular disease, hypertension, pulse pressure, LDL, logCRP, both fetuin-A and OPG were independently associated with cfPWV (p=0.024 and p=0.041 respectively). ccIMT was negatively associated with fetuin-A (r=-0.312, p=0.005) and positively with OPG (r=0.521, p<0.0001); however these associations lost statistical significance after adjustment for age.

CONCLUSION

In chronic hemodialysis patients both fetuin-A and OPG levels are independently associated with arterial stiffness but not with early atherosclerotic vascular changes.