Matrix carboxy glutamic acid protein serum level in type 2 diabetes mellitus patients with coronary artery disease

Poor glycemic control is a very strong independent predictor of vascular calcification which is a well known manifestation of atherosclerosis and plays a significant role in the development of cardiovascular complications in systemic disease. Different factors for initiating vascular calcification are proposed, these include matrix gamma carboxy glutamate protein (MGP), osteopontin and fetuin-A. MGP is a vitamin K-dependent extracellular matrix protein that binds to calcium ions and is involved in the prevention of vascular calcification. Aim: The present work aimed at evaluating serum level of matrix carboxy glutamic acid protein in type two diabetes mellitus male patients with coronary artery disease. Subjects and methods: The present study was conducted on eighty male patients divided into four main groups. The control group included 20 apparently healthy males, the ischemic group included 20 male patients suffered from ischemic heart disease, diabetic group included 20 male patients suffered from type 2 diabetes mellitus and the mixed group included 20 male patients suffered from both ischemic heart disease and type 2 diabetes mellitus. To all the studied subjects the following was done: thorough history taking , physical examination, electrocardiogram , ultrasound “Doppler” examination , plain X-ray and laboratory estimation of serum levels of : fasting and post prandial glucose, urea, creatinine, uric acid , lipid profile , calcium (total and ionized) and inorganic phosphate,quantitative C-reactive protein (CRP) , intact parathyroid and matrix carboxy glutamic acid protein ( MGP) in addition to estimation of blood glycated hemoglobin . Results: Doppler ultrasound showed increased values of the carotid intima media thickness in the mixed group followed by the ischemic and then the diabetic group and also detected vascular calcification in the patients group. MGP level was significantly higher in both the ischemic and the mixed group than in the control groups . In addition, diabetic patients with poor glycemic control showed significantly higher values of MGP when compared to diabetic patients with good glycemic control and the control group. Conclusion: The significant increase of MGP level in the ischemic and mixed groups than the control group reflects a compensatory mechanism to overcome the calcification process. In addition , its significant increase in patients with elevated HBA1c denotes that poor glycemic control is a very strong, independent predictor of vascular calcification