S.PEK1, SC LIM2, KKL ANG1, WE TANG3, CF SUM2, S TAVINTHARAN2
Khoo Teck Puat Hospital1, Admiralty Medical Centre2, NHG Polyclinics3
Myocardial infarction(MI) is a leading cause of death. Osteoprotegerin (OPG), a member of the tumor-necrosis-factor receptor superfamily, has been found in plaques and is associated with vascular calcification. We aim to identify baseline predictors, including OPG, of MI in a Type 2 Diabetes (T2D) cohort.
Patients with T2D were recruited from Yishun Polyclinic and Khoo Teck Puat Hospital, from 2011-2014(SMART2D cohort). Demographic, anthropometric and vascular measurements were collected. Cohort follow-up was conducted twice between 2014 – current and MI data was link through National Registry of Diseases(NRDO). Plasma OPG from fasted blood was measured by enzyme-linked immunosorbent assay (ELISA). Multivariable Cox proportional hazards regression was used to analyse baseline predictors of incident MI (STATA).
At baseline, 2266 patients were recruited. Baseline age:(57.3±11.0)years, duration of diabetes: 10.0(4.0-17.0)years and BMI:27.0(24.2-30.5)kg/m2, 1110(49.0%) males, ethnicity: 1158(51.1%) Chinese, 491(21.7%) Malays, 526(23.2%) Indians. 79(3.5%) of them had a previous MI and 121 patients had incident MI, with a mean follow-up of 30months. Patients with incident MI were significantly older, had longer duration of diabetes, higher blood pressure, higher fasting glucose, lower HDL, higher triglycerides, lower eGFR, higher urine ACR, and higher plasma OPG levels (all p<0.05). After adjustment for age, gender, ethnicity, BMI, systolic blood pressure, LDL, eGFR, urine ACR and presence of PAD, diabetes duration (β: 0.022, SE: 0.011, p=0.045) and log-transformed OPG (β: 1.537, SE: 0.685, p=0.025) remained statistically significant.
Baseline plasma OPG and duration of diabetes predicts incident cardiovascular outcomes in the diabetes population. Mechanism of OPG-RANKL pathway in MI needs further investigation.