title: Serum Bone Morphogenic Protein-4 Contributes to Discriminating Coronary Artery Disease Severity.
abstract: Bone morphogenic protein 4 (BMP-4) is a known pro-inflammatory and pro-atherogenic cytokine. Here, we investigated whether the serum BMP-4 level predicts coronary artery disease (CAD) severity in humans. We measured serum BMP-4 concentrations in 1044 consecutive patients who underwent elective coronary angiography and percutaneous coronary intervention. CAD severity was estimated by the number of diseased vessels showing ≥ 50% diameter stenosis. Among males, the serum BMP-4 level was significantly lower in patients with multivessel disease (MVD) compared with those with single-vessel disease (SVD) (16.3 ± 22.6 vs. 22.0 ± 28.4 pg/mL, P < 0.01). After adjustment for other cardiovascular risk factors, a high serum BMP-4 level was an independent predictor for a decreased risk of MVD (odds ratio, 0.992; 95% confidence interval [CI], 0.985-0.998; P =  .01) and patients in the lower tertile were 1.55-fold more likely to have MVD compared with upper tertile patients. Receiver-operating characteristic curve analysis demonstrated that the serum BMP-4 level had a 54% sensitivity and 54% specificity for predicting MVD (area under the curve [AUC], 56.5%; 95% CI, 51.9-61.0%; P < 0.01). Serum BMP-4 improved the predictive capability of risk factors for MVD (AUC with and without BMP-4: 64.9 and 63.6%, respectively). Considering the likelihood ratio and number of parameters, adding the serum BMP-4 level provided a better-fit model for predicting MVD compared with the model consisting of conventional risk factors (likelihood ratio χ2 = 6.20, P =  .01). However, an association between serum BMP-4 and CAD was not observed in females.Serum BMP-4 levels are independently associated with CAD severity and contribute to discriminating CAD severity in males.
authors.affiliation: From the Department of Internal Medicine, College of Medicine (CSP, O-KH, MKK, WBC, YSC, K-HB, K-HS, YL, HSK); Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine (CSP, WBC, YSC, MYL); and Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (MKK, K-HB, K-HS, HSK).
authors.forename: Chul Soo
authors.initials: CS
authors.lastname: Park
authors.forename: Oak-Kee
authors.initials: OK
authors.lastname: Hong
authors.forename: Mee Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Woo Baek
authors.initials: WB
authors.lastname: Chung
authors.forename: Yun Seok
authors.initials: YS
authors.lastname: Choi
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Baek
authors.forename: Ki-Ho
authors.initials: KH
authors.lastname: Song
authors.forename: Man Young
authors.initials: MY
authors.lastname: Lee
authors.forename: Hyuk-Sang
authors.initials: HS
authors.lastname: Kwon
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D055415:Bone Morphogenetic Protein 4 / Q000097:blood*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
chemical_list: C525809:BMP4 protein, human; D015415:Biomarkers; D055415:Bone Morphogenetic Protein 4