Increased Serum Parathyroid Hormone, Osteocalcin and Alkaline Phosphatase Are Associated with a Long-Term Adverse Cardiovascular Outcome after Coronary Artery Bypass Graft Surgery

Abstract

Despite the fact that an association of osteopoenia/osteoporosis with elevated risk of coronary artery calcification (CAC) and coronary atherosclerosis (CA) is well-established, it remains unclear whether bone turnover markers can be employed in long-term prognostication of such patients. Here we measured serum calcium, phosphate, calcitonin, parathyroid hormone (PTH), osteoprotegerin, osteocalcin, osteopontin, alkaline phosphatase and its bone isoenzyme, subsequently correlating them with an adverse cardiovascular outcome after 3 years of follow-up. The extent of brachiocephalic artery stenosis, CA, or CAC, as well as prevalence of osteopoenia/osteoporosis before the coronary artery bypass graft (CABG) surgery, did not differ between outcome groups, suggesting that subtle molecular mechanisms might be involved in determining the outcome rather than clinical or subclinical disease. After stepwise logistic regression, serum osteocalcin > 26.8 ng/mL and PTH > 49.1 pg/mL were independent predictors of an adverse outcome. Serum ionised calcium correlated with multivessel coronary artery disease; moreover, patients with severe CA (SYNTAX score > 21) had higher serum ionised calcium than those with mild CA. Likewise, serum alkaline phosphatase was associated with severe CA and CAC (Agatston score > 400). In conclusion, serum PTH, osteocalcin, and alkaline phosphatase are associated with an adverse cardiovascular outcome 3 years after CABG surgery regardless of osteopoenia/osteoporosis, coronary/peripheral atherosclerosis, and CAC.

Serum biomarkers for arterial calcification in humans: A systematic review

“…Thirty-five studies investigated a possible association between phosphate and arterial calcification ( Alagoz et al, 2014 ; Billington et al, 2020 ; Chen et al, 2006 ; Criqui et al, 2010 ; Foley et al, 2009 ; Grønhøj et al, 2016 ; Kim et al, 2013 ; Kwak et al, 2014 ; Liang et al, 2021 ; Nam et al, 2017 ; Nielsen et al, 2021 ; Park et al, 2011 ; Park et al, 2016 ; Shin et al, 2012 ; Tuersun et al, 2020 ; Tuttle and Short, 2009 ; Wei et al, 2020 ; Wu et al, 2016b ; Barbarash et al, 2016 ; Cancela et al, 2012 ; Chai et al, 2017 ; Diederichsen et al, 2017 ; Donate-Correa et al, 2019 ; Golovkin et al, 2016 ; Liu et al, 2019 ; Masai et al, 2013 ; Pirro et al, 2013 ; Schlieper et al, 2010 ; Torii et al, 2016 ; Awan et al, 2010 ; Razavi et al, 2021 ; Martín-Reys et al, 2016 ; Barbarash et al, 2019 ; McPherson et al, 2012 ; Park et al, 2020 ). Of these studies, fourteen reported a significant positive association ( Foley et al, 2009 ; Kim et al, 2013 ; Kwak et al, 2014 ; Park et al, 2011 ; Park et al, 2016 ; Shin et al, 2012 ; Tuersun et al, 2020 ; Tuttle and Short, 2009 ; Cancela et al, 2012 ; Diederichsen et al, 2017 ; Barbarash et al, 2019 ; McPherson et al, 2012 ; Park et al, 2020 ), three a negative association ( Chen et al, 2006 ; Kim et al, 2013 ; Razavi et al, 2021 ...…”

“…The other was of moderate to high quality of evidence ( Liu et al, 2019 ). Of the nine articles with a positive association in a cross-sectional design, one study was not corrected for possible confounders ( Barbarash et al, 2019 ). The other eight articles were of low to moderate quality of evidence ( Kim et al, 2013 ; Kwak et al, 2014 ; Park et al, 2011 ; Park et al, 2016 ; Shin et al, 2012 ; Tuersun et al, 2020 ; Cancela et al, 2012 ; Park et al, 2020 ).…”

Clinical and biochemical markers of coronary artery calcification progression after elective coronary artery bypass grafting

“…Имеются данные, свидетельствующие о том, что развитие сосудистой и клапанной кальцификации, остеопороза и атеросклероза могут быть опосредованы общими патофизиологическими механизмами, а также модулироваться одними и теми же биологическими маркерами [1,2,5,6]. Такая концепция получила название "остео-коронарной коморбидности" [7].…”

Fundamental and practical aspects of coronary artery calcification

“…Более чем у половины пациентов по данным МСКТ были признаки выраженного ККА [20]. Риск развития в течение трех лет после КШ неблагоприятных сердечнососудистых событий (фатальных и нефатальных острых сосудистых событий и возврата стенокардии) ассоциировался с исходно высокими значениями биологических маркеров костного метаболизма: остеокальцина и паратиреоидного гормона, что отражало наличие и эффекты остео-коронарной коморбидности [44].…”