ADA: New CVD Predictor for Type 1 Diabetes Found

Serum osteoprotegerin is an independent predictor of cardiovascular complications…

Serum osteoprotegerin (OPG) is an independent predictor of cardiovascular complications in adults with type 1 diabetes, according to a new analysis from the ongoing Finnish Diabetic Nephropathy (FinnDiane) Study.

Daniel Gordin, MD, DMSC, a nephrologist at Helsinki University Central Hospital reported that, in the observational study of nearly 2,000 adults, serum OPG concentrations at baseline were significantly higher in the 190 patients who had an incident CVD event during 10.4 years of follow-up: 2.2 mg/L versus 1.6 mg/L in those who did not (P<0.001).

After adjustment for other factors associated with CVD, OPG remained an independent predictor of cardiovascular events (HR=1.21, 95% CI 1.01-1.45; P=0.035).

OPG was also an independent predictor of peripheral vascular disease, the study showed.

Gordin said, "This biomarker can add value in evaluating patients for vascular disease." He also noted that osteoprotegerin is known to be involved in vascular calcification of the arteries. "Since this process is accelerated in patients with diabetes, we asked the question of whether it was an independent predictor of cardiovascular disease and mortality."

To find out, he and his colleagues measured serum OPG in 1,939 adults with type 1 diabetes participating in the FinnDiane study. Patients with end-stage renal disease at baseline were excluded from the analysis.

Data on cardiovascular events and mortality during follow-up were verified from hospital discharge registries (ICD codes) and the Finnish National Death Registry, respectively.

Results showed that only patients with macroalbuminuria and/or renal impairment had elevated OPG concentrations, when compared with participants who did not have overt kidney disease.

Patients with retinopathy or CVD also had higher OPG concentrations, but this was attributable to their frequency of chronic kidney disease.

• Serum OPG concentrations at baseline were significantly higher in the 80 patients who had a leg revascularization procedure or amputation during follow-up: 2.0 mg/L versus 1.6 mg/L in those who did not (P<0.001). After adjustment for other factors associated with OPG levels and peripheral vascular disease, OPG remained an independent predictor of PVD events (HR=1.46, 95% CI 1.13-1.88; P=0.004).
• Serum OPG concentrations at baseline were significantly higher in the 166 patients who died during follow-up: 2.0 mg/L versus 1.6 mg/L in those who did not (P=0.006). After adjustment, however, serum OPG was no longer a significant predictor of death.
• There was no significant association between serum OPG and incident coronary heart disease or stroke.

Gordin also noted that experimental data supports a causal role for OPG in the development of CVD, although further study is needed.

Gordin D et al "Osteoprotegerin is an independent predictor of vascular events in FinnishAdults with type 1 diabetes" Diab Care 2013; 36: 1827–1833; DOI: 10.2337/dc12-2170.