Sclerostin to predict coronary artery disease severity

Sclerostin is an extracellular inhibitor of the canonical Wnt/β-catenin signaling pathway. However, the relationship between sclerostin levels in patients with coronary artery disease (CAD) and the severity of their condition remains unclear. This investigation aimed to determine if a specific sclerostin cutoff value correlates with the degree of CAD.

We consecutively enrolled 290 patients who underwent investigation at a catheterization laboratory. The study population comprised a control group of 140 patients with normal coronary arteries and a CAD group of 150 patients with angiographically confirmed coronary lesion(s). The severity of CAD was assessed using Gensini and SYNTAX scores.

Patients with CAD exhibited significantly higher sclerostin levels compared to control group (p<0.01). Univariate linear regression analysis demonstrated that sclerostin levels were significantly correlated with and independently predicted both the Gensini score (β = 0.040, 95% CI: 0.014-0.066, p=0.03) and the SYNTAX score (β = 0.025, 95% CI: 0.015-0.035, p<0.01). At a cutoff level of >235 pg/mL, sclerostin showed a specificity of 82.5% and a sensitivity of 60%. Sclerostin had the largest area under the receiver operating characteristic (ROC) curve (0.769 ± 0.053, p<0.01). In a population with a 10% CAD prevalence, the positive and negative predictive values of sclerostin were calculated as 27.8% and 94.86%, respectively.

Plasma sclerostin levels are elevated in patients with CAD and correlate with the severity of the disease. These findings suggest that sclerostin may have potential as a biochemical marker for the diagnosis or risk stratification of CAD.