Abstract
BackgroundCardiovascular disease (CVD) is frequent in type 2 diabetes mellitus patients due to accelerated atherosclerosis. Plasma osteoprotegerin (OPG) has evolved as a biomarker for CVD. We examined the relationship between plasma OPG levels and different CVD manifestations in type 2 diabetes.MethodsType 2 diabetes patients without known CVD referred consecutively to a diabetes clinic for the first time (n = 305, aged: 58.6 ± 11.3 years, diabetes duration: 4.5 ± 5.3 years) were screened for carotid arterial disease, peripheral arterial disease, and myocardial ischemia by means of carotid artery ultrasonography, peripheral ankle and toe systolic blood pressure measurements, and myocardial perfusion scintigraphy (MPS). In addition, plasma OPG concentrations and other CVD-related markers were measured.ResultsThe prevalence of carotid arterial disease, peripheral arterial disease, and myocardial ischemia was 42%, 15%, and 30%, respectively. Plasma OPG was significantly increased in patients with carotid and peripheral arterial disease compared to patients without (p < 0.001, respectively), however, this was not the case for patients with myocardial ischemia versus those without (p = 0.71). When adjusted for age, HbA1c and U-albumin creatinine ratio in a multivariate logistic regression analysis, plasma OPG remained strongly associated with carotid arterial disease (adjusted OR: 2.12; 95% CI: 1.22-3.67; p = 0.008), but not with peripheral arterial disease or myocardial ischemia.ConclusionsIncreased plasma OPG concentration is associated with carotid and peripheral arterial disease in patients with type 2 diabetes, whereas no relation is observed with respect to myocardial ischemia on MPS. The reason for this discrepancy is unknown.Trial registration numberat http://www.clinicaltrial.gov: NCT00298844
Highlights
Cardiovascular disease (CVD) is frequent in type 2 diabetes mellitus patients due to accelerated atherosclerosis
The plasma OPG concentrations were significantly increased in patients with carotid arterial disease and peripheral arterial disease (PAD) compared to patients without (1.28 (0.99-1.61) versus 1.04 (0.80-1.33) μg/l, p < 0.001 and 1.47 (1.02-1.89) versus 1.08 (0.85-1.40) μg/l, p < 0.001, respectively) (Table 2 and Figure 1)
The upper quartile of plasma OPG and myocardial ischemia were tested in a univariate logistic regression analysis and did not show any relationship (OR: 1.46; 95% confidence intervals (CI): 0.85-2.53; p = 0.172)
Summary
Cardiovascular disease (CVD) is frequent in type 2 diabetes mellitus patients due to accelerated atherosclerosis. Plasma osteoprotegerin (OPG) has evolved as a biomarker for CVD. We examined the relationship between plasma OPG levels and different CVD manifestations in type 2 diabetes. Cardiovascular disease (CVD) is the leading cause of death in type 2 diabetes mellitus patients [1,2], as many suffer from coronary heart disease, cerebrovascular disease, and/or peripheral arterial disease (PAD) [3,4,5]. We have previously observed significantly higher concentrations of OPG in arteries from patients with diabetes compared to non-diabetics [10]. The pathophysiological connection between plasma OPG concentrations and CVD is not known, but relations to both arterial disease as well as to diseased myocardium has been suggested [13,14]
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