Serum sclerostin and adverse outcomes in elderly patients with stable coronary artery disease undergoing percutaneous coronary intervention

Wuyang He,Qingwei Chen,Tingting Xiang,Jun Pang,Chunqiu Li,Peng Wang

doi:10.1007/s40520-019-01393-2

Abstract

BackgroundRecently, sclerostin, a bone-derived protein, has been shown to play a key role in atherosclerosis progression. However, few studies have investigated the influence of sclerostin on cardiovascular disease prognosis. We investigated the relationship between serum sclerostin levels and adverse outcomes in elderly patients with stable coronary artery disease (SCAD) who were undergoing percutaneous coronary intervention (PCI).MethodsWe enrolled 310 elderly SCAD patients who underwent PCI in this study and followed them 3 years. According to the median serum sclerostin levels, subjects were stratified into a low sclerostin (low scl) group (n = 144) and a high sclerostin (high scl) group (n = 166). Time-to-event analyses were performed with the Kaplan–Meier method. Associations between sclerostin levels and main adverse cardiovascular and cerebrovascular events (MACCEs) and mortality were evaluated by Cox multivariate regression analysis. The prognostic power of predictive models was verified by the concordance index and receiver operating characteristic curve analysis.ResultsThe high scl group had a significantly higher MACCE-free rate and better survival than the low scl group. Serum sclerostin was an independent predictor and could improve the prognostic power for adverse outcomes. In addition, serum sclerostin levels were significantly associated with bone turnover markers, a lower presence of multivessel disease and a lower CCS angina class.ConclusionsSerum sclerostin is a prognostic parameter for predicting and intervening in the adverse outcomes of elderly SCAD patients undergoing PCI, which may be explained by its potential role in the bone–vascular axis.

Highlights

Coronary heart disease (CHD) has become the leading cause of death worldwide, increasing both mortality and the risk of disability in the elderly population
All subjects were stratified into two groups according to the median value of serum sclerostin levels (179.5 pg/mL)
Our study revealed that elderly stable coronary artery disease (SCAD) patients with high sclerostin levels had a significantly lower incidence rate of main adverse cardiovascular and cerebrovascular events (MACCEs) and better survival after percutaneous coronary intervention (PCI)

Summary

Introduction

Coronary heart disease (CHD) has become the leading cause of death worldwide, increasing both mortality and the risk of disability in the elderly population. Sclerostin, an antagonist in the canonical Wnt-signaling pathway, can inhibit ectopic calcification in the vasculature, exerting its potential protective role by attenuating the progression of atherosclerosis [7]. We investigated the relationship between serum sclerostin levels and adverse outcomes in elderly patients with stable coronary artery disease (SCAD) who were undergoing percutaneous coronary intervention (PCI). Associations between sclerostin levels and main adverse cardiovascular and cerebrovascular events (MACCEs) and mortality were evaluated by Cox multivariate regression analysis. Serum sclerostin levels were significantly associated with bone turnover markers, a lower presence of multivessel disease and a lower CCS angina class. Conclusions Serum sclerostin is a prognostic parameter for predicting and intervening in the adverse outcomes of elderly SCAD patients undergoing PCI, which may be explained by its potential role in the bone–vascular axis

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Results

Discussion

Conclusion