Osteoprotegerin improves risk detection by traditional cardiovascular risk factors and hsCRP

• Published in: Heart (British Cardiac Society) Vol. 99; no. 2; pp. 106 - 110
• Main Authors: Mogelvang, Rasmus, Haahr-Pedersen, Sune, Bjerre, Mette, Frystyk, Jan, Iversen, Allan, Galatius, Søren, Flyvbjerg, Allan, Jensen, Jan Skov
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.01.2013; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; C-Reactive Protein - metabolism; Cardiology. Vascular system; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Cause of Death - trends; Early Diagnosis; Female; Follow-Up Studies; Health risk assessment; Heart attacks; Humans; Male; Medical sciences; Middle Aged; Mortality; Osteoprotegerin - blood; Population Surveillance; Predictive Value of Tests; Prevalence; Proportional Hazards Models; Prospective Studies; Risk Factors; Studies; Survival Rate - trends; Time Factors; Young Adult; Vascular disease; Atherosclerosis; Risk factor; Cardiovascular disease; Risk; Circulatory system; Cardiology; Medical screening; Detection
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2012-302240

Objective To evaluate the association of plasma osteoprotegerin (OPG) to hospitalisation for ischaemic heart disease (IHD), ischaemic stroke and all-cause mortality, and the effect of combining plasma OPG and high-sensitivity C-reactive protein (hsCRP). Design OPG and hsCRP concentrations were measured at baseline in a large Danish prospective community-based population study. Setting The 4th Copenhagen City Heart Study. Participants 5863 men and women aged 20–95 were recruited from the general population. Main outcome measures Combined end-point of IHD, ischaemic stroke or all-cause mortality. Results During a median follow-up of 7.8 years (IQR 7.3–8.3), 1270 subjects (21.7%) reached the combined end-point. A twofold increase in plasma OPG was a significant predictor of the combined end-point (univariable HR 1.85, 95% CI 1.75 to 1.96; p<0.001). In a multivariable Cox-regression model containing age, male sex, hypertension, diabetes, hypercholesterolaemia, present or former smoking, glomerular filtration rate, prior IHD, prior ischaemic stroke, hsCRP and plasma OPG, high concentrations of hsCRP and plasma OPG were independent predictors of the combined end-point. The two biomarkers interacted statistically (p<0.001). Compared to low hsCRP and low OPG (n=1927), either high hsCRP or high OPG (univariable HR 2.38, 95% CI 2.02 to 2.80, p<0.001; n=2816), or both high hsCRP and high OPG (univariable HR 5.13, 95% CI 4.29 to 6.13, p<0.001; n=775) conferred increased risk of the combined end-point. Conclusions OPG is an independent predictor of the combined end-point of hospitalisation of IHD, ischaemic stroke and all-cause mortality. The combination of plasma OPG and hsCRP provides more prognostic information than the individual effect of the two biomarkers.