PROGNOSTIC VALUE OF OSTEOPROTEGERIN IN ASSESSING RISK OF CARDIOVASCULAR COMPLICATIONS AND OSTEOPOROTIC FRACTURES IN COMORBID PATHOLOGY
CHYNGYSHPAEV D.SH, KERIMALY M, PASANOVA A.M, ALYMKULOV A.T, UZAKOVA A.O, UZAKOV O.J.
Key words:
OSTEOPROTEGERIN, RISK FACTORS, HEART FAILURE, DIABETES MELLITUS, OSTEOPOROSIS, PROGNOSIS
Abstract:
Introduction. To study the predictive role of serum levels of osteoprotegerin (OPG) for risk stratification of adverse cardiovascular events and bone fractures in women with comorbid pathologies, including chronic heart failure (CHF), type 2 diabetes mellitus (DM 2) and osteoporosis.
Materials and methods. The study involved 78 women aged 50 to 65 years (mean age 57.1±4.9 years) with CHF, DM 2 and osteoporosis, presented in two groups. Group 1 (n=41) included patients with OPG level ≤ 6.8 pmol/l, group 2 (n=37) included patients with OPG level > 6.8 pmol/l. The control group included 35 postmenopausal women, aged 50-65 years, without clinical disorders of hemodynamics, carbohydrate and mineral metabolism. The content of serum OPG was determined by solid-phase enzyme-linked immunoassay. Assessment of bone mineral density (BMD) was carried out by densitometry using dual X-ray absorptiometry. Outcomes. In women with an OPG level >6.8 pmol/l, adverse cardiovascular events and osteoporotic fractures were significantly more frequently recorded. A significant (p<0.001) increase in the OPG level was found in patients of the 1st and 2nd groups compared with the control group (2.3±0.4 pmol/l, p=0.001). A decrease in the risk of cardiovascular events was revealed at OPG concentration ≤ 6.8 pmol/l: myocardial infarction (OR=0.91 [95% CI 0.83-0.98; p=0.04]), cerebral stroke (OR =0.87 [95% CI 0.81-0.98; p=0.01]), decompensated CHF (OR=0.84 [95% CI 0.77-0.92; p=0.02] ), osteoporotic bone fractures (OR=0.81 [95% CI 0.72-0.90; p=0.01]); the risk of death from all the causes did not change significantly (OR: 0.98 [95% CI 0.94-1.05; p=0.223]). An OPG level > 6.8 pmol/l (sensitivity - 91%, specificity - 53%) makes it possible to predict the onset of adverse cardiovascular events with a high probability in patients with IHD with CD 2 and osteoporosis (AUC (Area Under Curve) = 0, 83 (95% CI [0.72-0.93; p=0.001]).
Conclusion. Osteoprotegerin is an independent risk factor for the development of adverse cardiovascular events and bone fractures in women with comorbid pathologies, including CHF, type 2 diabetes, and osteoporosis. It seems clinically reasonable to determine the concentration of OPG in the blood to stratify the risk of adverse cardiovascular events and bone fractures in women with CHF associated with type 2 diabetes and osteoporosis.