Prognostic value of osteoprotegerin in heart failure after acute myocardial infarction.
OBJECTIVE
We sought to determine the relationship between osteoprotegerin (OPG) and clinical outcomes in patients with heart failure (HF) after acute myocardial infarction (AMI).


BACKGROUND
Arterial calcification is a prominent feature of arterial atherosclerosis and is associated with the occurrence of AMI. Osteoprotegerin is a recently discovered member of the tumor necrosis superfamily that may link the skeletal with the vascular system.


METHODS
We assayed plasma OPG levels in 234 patients with AMI complicated with HF and their relation to adverse outcomes during follow-up in patients randomly assigned to angiotensin-converting enzyme inhibition or angiotensin II antagonism. Blood was sampled at baseline (median three days after AMI), one month, and at one and two years.


RESULTS
Elevated plasma levels of OPG at baseline were associated with adverse outcomes during a median of 27 months follow-up; OPG remained an independent prognostic indicator also after adjustment for other known predictors of mortality and cardiovascular events after AMI (e.g., creatinine clearance, N-terminal B-type natriuretic peptide, high-sensitivity C-reactive protein). In non-survivors, plasma OPG levels were persistently elevated during longitudinal testing, suggesting that OPG may be of value for monitoring patients at risk.


CONCLUSIONS
Osteoprotegerin is a novel marker for cardiovascular mortality and clinical events in patients with AMI complicated with HF. These findings are compatible with the hypothesis suggesting a possible association between mediators of bone homeostasis and cardiovascular disease.
Ueland
Thor
T
Research Institute for Internal Medicine, Section of Endocrinology, National University Hospital, Oslo, Norway. thor.ueland@klinmed.uio.no <thor.ueland@klinmed.uio.no>
Jemtland
Rune
R
Godang
Kristin
K
Kjekshus
John
J
Hognestad
Aina
A
Omland
Torbjørn
T
Squire
Iain B
IB
Gullestad
Lars
L
Bollerslev
Jens
J
Dickstein
Kenneth
K
Aukrust
Pål
P
D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006023:Glycoproteins / Q000097:blood*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D053244:Osteoprotegerin; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018160:Receptors, Cytoplasmic and Nuclear / Q000097:blood*; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood*; D012680:Sensitivity and Specificity; D016019:Survival Analysis
D006023:Glycoproteins; D053244:Osteoprotegerin; D018160:Receptors, Cytoplasmic and Nuclear; D018124:Receptors, Tumor Necrosis Factor; C506030:TNFRSF11B protein, human