title: Can osteoprotegerin be used to identify the presence and severity of coronary artery disease in different clinical settings?
abstract: OBJECTIVE
  The biomarker Osteoprotegerin (OPG) is associated with coronary artery disease (CAD). The main purpose of this study was to evaluate the diagnostic value of OPG in healthy subjects and in patients with suspected angina pectoris (AP).
  
  
  METHODS
  A total of 1805 persons were enrolled: 1152 healthy subjects and 493 patients with suspected AP. For comparison 160 patients with acute myocardial infarction (MI) were included. To uncover subclinical coronary atherosclerosis, a non-contrast cardiac-CT scan was performed in healthy subjects; while in patients with suspected AP a contrast coronary angiography was used to detect significant stenosis. OPG concentrations were analyzed and compared between groups. ROC-analyses were performed to estimate OPG cut-off values.
  
  
  RESULTS
  OPG concentrations increased according to disease severity with the highest levels found in patients with acute MI. No significant difference (p = 0.97) in OPG concentrations was observed between subgroups of healthy subjects according to severity of coronary calcifications. A significant difference (p < 0.0001) in OPG concentrations was found between subgroups of patients with suspected stable AP according to severity of CAD. ROC-analysis showed an AUC of 0.62 (95% CI: 0.57-0.67). The optimal cut-off value of OPG (<2.29 ng/mL) had a sensitivity of 56.2% (95% CI: 49.2-63.0%) and a specificity of 62.9% (95% CI: 57.3-68.2%).
  
  
  CONCLUSIONS
  OPG cannot be used to differentiate between healthy subjects with low versus high levels of coronary calcifications. In patients with suspected AP a single OPG measurement is of limited use in the diagnosis of CAD.
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark; OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. Electronic address: susanne.hosbond@rsyd.dk.
authors.forename: Susanne Elisabeth
authors.initials: SE
authors.lastname: Hosbond
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark; Centre for Individualized Medicine of Arterial Diseases, Odense University Hospital, Denmark; OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
authors.forename: Axel Cosmus Pyndt
authors.initials: AC
authors.lastname: Diederichsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark; OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
authors.forename: Lotte
authors.initials: L
authors.lastname: Saaby
authors.affiliation: Department of Biochemistry and Pharmacology, Odense University Hospital, Denmark; Centre for Individualized Medicine of Arterial Diseases, Odense University Hospital, Denmark.
authors.forename: Lars Melholt
authors.initials: LM
authors.lastname: Rasmussen
authors.affiliation: Department of Cardiology, Odense University Hospital, Svendborg, Denmark.
authors.forename: Jess
authors.initials: J
authors.lastname: Lambrechtsen
authors.affiliation: Department of Cardiology, Lillebaelt Hospital, Vejle Hospital, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Munkholm
authors.affiliation: Department of Cardiology, Hospital of South West Denmark, Esbjerg, Denmark; Institute of Regional Health Services Research, University of Southern Denmark, Denmark.
authors.forename: Niels Peter Rønnow
authors.initials: NP
authors.lastname: Sand
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Denmark; Centre of Health Economics Research, University of Southern Denmark, Denmark.
authors.forename: Oke
authors.initials: O
authors.lastname: Gerke
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Tina Svenstrup
authors.initials: TS
authors.lastname: Poulsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark; OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Mickley
mesh_terms: D000787:Angina Pectoris / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology; D019540:Area Under Curve; D015415:Biomarkers; D002114:Calcinosis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology; D002118:Calcium / Q000032:analysis; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology; D003327:Coronary Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D006973:Hypertension / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology; D053244:Osteoprotegerin / Q000097:blood*; D012372:ROC Curve; D012494:Sampling Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000097:blood / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D053244:Osteoprotegerin; C506030:TNFRSF11B protein, human; D002118:Calcium
keywords: Coronary artery disease; Coronary calcification; Diagnostic utility; Osteoprotegerin