title: Prognostic value of osteoprotegerin in heart failure after acute myocardial infarction.
abstract: 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.
authors.affiliation: Research Institute for Internal Medicine, Section of Endocrinology, National University Hospital, Oslo, Norway. thor.ueland@klinmed.uio.no <thor.ueland@klinmed.uio.no>
authors.forename: Thor
authors.initials: T
authors.lastname: Ueland
authors.forename: Rune
authors.initials: R
authors.lastname: Jemtland
authors.forename: Kristin
authors.initials: K
authors.lastname: Godang
authors.forename: John
authors.initials: J
authors.lastname: Kjekshus
authors.forename: Aina
authors.initials: A
authors.lastname: Hognestad
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
authors.forename: Iain B
authors.initials: IB
authors.lastname: Squire
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.forename: Jens
authors.initials: J
authors.lastname: Bollerslev
authors.forename: Kenneth
authors.initials: K
authors.lastname: Dickstein
authors.forename: Pål
authors.initials: P
authors.lastname: Aukrust
mesh_terms: 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
chemical_list: D006023:Glycoproteins; D053244:Osteoprotegerin; D018160:Receptors, Cytoplasmic and Nuclear; D018124:Receptors, Tumor Necrosis Factor; C506030:TNFRSF11B protein, human