Bone morphogenetic protein 10 and one-year outcomes after open revascularisation in symptomatic peripheral arterial disease or carotid stenosis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Symptomatic peripheral arterial disease or carotid stenosis (n=210). Intervention: Bone morphogenetic protein 10 (BMP10) levels vs. Lower BMP10 levels. Primary outcome: Major adverse cardiovascular events (MACE) (HR 1.01, 95% CI 1.00-1.03, p=0.047).

Q: What does this research mean for the field?

Higher circulating BMP10 levels are associated with increased risk of major adverse cardiovascular events and all-cause mortality, but not new-onset atrial fibrillation, within one year following open revascularisation for symptomatic peripheral arterial disease or carotid stenosis. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sofia Skröder; Dritan Poçi; Daniel R. Smith; Mats Dreifaldt; Allan Sirsjö; Espen Fengsrud; Anna Björkenheim; Liza U. Ljungberg

doi:10.1186/s12872-026-06568-0

September 16, 2026BMC Cardiovascular DisordersOpen Access

Bone morphogenetic protein 10 and one-year outcomes after open revascularisation in symptomatic peripheral arterial disease or carotid stenosis

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Why the study?

Are higher circulating BMP10 levels associated with new-onset AF, MACE, and all-cause mortality in patients undergoing open revascularisation for symptomatic PAD or carotid stenosis?

Key Points

To investigate whether circulating bone morphogenetic protein 10 (BMP10) concentrations are associated with new-onset atrial fibrillation, major adverse cardiovascular events (MACE), and all-cause mortality following open revascularisation for symptomatic peripheral arterial disease or carotid stenosis.
Enrolled 210 patients (63% men; 61% undergoing surgery for peripheral arterial disease and 39% for carotid stenosis) scheduled for endarterectomy.
Measured circulating BMP10 concentrations via multiplex immunoassay and evaluated clinical outcomes during one-year follow-up using medical records.
Assessed associations between BMP10 and clinical endpoints using unadjusted as well as age- and sex-adjusted Cox proportional hazards regression models.
In unadjusted Cox regression, higher BMP10 concentrations were significantly associated with MACE (HR 1.01, 95% CI 1.00-1.03; p = 0.047) and all-cause mortality (HR 1.03, 95% CI 1.01–1.04; p < 0.001), with similar risk estimates after adjusting for age and sex.
During one-year follow-up, 26 patients experienced MACE and 13 died, while baseline circulating BMP10 levels were significantly higher in women than in men (median 39.9 pg/mL vs. 37.2 pg/mL; p = 0.045).

Study Design

Type

Cohort (n=210)

Multicenter

Yes

Structured PICO

Are higher circulating BMP10 levels associated with new-onset AF, MACE, and all-cause mortality in patients undergoing open revascularisation for symptomatic PAD or carotid stenosis?

P

Population

210 patients (median age 76 years, 36.7% female) undergoing endarterectomy for symptomatic peripheral arterial disease or carotid stenosis, followed for one year.

E

Exposure

Measurement of circulating bone morphogenetic protein 10 (BMP10) levels

O

Outcome

New-onset atrial fibrillation (AF), major adverse cardiovascular events (MACE; composite of non-fatal ischaemic stroke, non-fatal acute myocardial infarction, and all-cause mortality), and all-cause mortality during one-year follow-upcomposite

Main Result

Hazard Ratio: 1.01 (95% CI 1–1.03)

p-value: p=0.047

Limitations

Observational design precludes causal conclusions
Small number of outcome events limited statistical precision and multivariable adjustment
Lack of systematic rhythm monitoring may have led to undetected asymptomatic or paroxysmal atrial fibrillation
Reliable adjudication of cause-specific mortality was not available
Potential selection bias due to exclusion of 24 participants with inaccessible clinical records
Residual confounding is likely due to the limited set of covariates in the adjusted models
Selection bias cannot be excluded as 24 potentially eligible participants were excluded due to inaccessible clinical records
Pooled patients with symptomatic PAD and CS, which are clinically and pathophysiologically distinct
Systematic or prolonged rhythm monitoring was not performed, potentially underestimating new-onset AF
Residual confounding is likely due to restricted set of covariates in adjusted models
No adjustment for multiple testing, making p-values nominal

Implication

Higher circulating BMP10 levels are associated with an increased risk of MACE and all-cause mortality, but not new-onset AF, at one year following endarterectomy for symptomatic PAD or carotid stenosis.

Abstract

Background Bone morphogenetic protein 10 (BMP10) has atrial-specific and vascular properties and may reflect both atrial and vascular pathophysiology. We investigated whether BMP10 levels were associated with new-onset atrial fibrillation (AF), major adverse cardiovascular events (MACE), and all-cause mortality after open revascularisation for symptomatic peripheral arterial disease (PAD) or carotid stenosis (CS). Methods Patients scheduled for endarterectomy for symptomatic PAD or CS were enrolled. BMP10 concentrations were measured using a multiplex immunoassay. Clinical outcomes were obtained from medical records during one-year follow-up. Associations between BMP10 and outcomes were assessed using Cox proportional hazards regression. Results A total of 210 patients were included (63% men; 61% underwent surgery for PAD). Women were older than men and had higher BMP10 levels. Forty patients had known preoperative AF. During one-year follow-up, 26 patients experienced MACE and 13 died. Among 170 patients without AF at baseline, 10 developed new-onset AF. In unadjusted Cox regression, higher BMP10 levels were associated with MACE (HR 1.01, 95% CI 1.00-1.03; p = 0.047) and all-cause mortality (HR 1.03, 95% CI 1.01–1.04; p < 0.001), but not with new-onset AF (HR 1.00, 95% CI 0.97–1.03; p = 0.80). Effect estimates were similar after adjustment for age and sex. Model-based point estimates of one-year cumulative incidence were numerically higher at higher BMP10 concentrations for MACE and all-cause mortality, although confidence intervals were wide; no corresponding pattern was observed for new-onset AF. Conclusions In this exploratory cohort, higher BMP10 levels were associated with MACE and all-cause mortality after endarterectomy for symptomatic PAD or CS. Women had higher BMP10 levels than men. These findings should be interpreted cautiously and considered hypothesis-generating; larger studies are required to validate the observed associations.

Discussion

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Cite This Study

Skröder et al. (2026) conducted a cohort in Symptomatic peripheral arterial disease or carotid stenosis (n=210). Bone morphogenetic protein 10 (BMP10) levels vs. Lower BMP10 levels was evaluated on Major adverse cardiovascular events (MACE) (HR 1.01, 95% CI 1.00-1.03, p=0.047).

synapsesocial.com/papers/6aabb69c5f706d05830e52bc https://doi.org/10.1186/s12872-026-06568-0

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Bone morphogenetic protein 10 and one-year outcomes after open revascularisation in symptomatic peripheral arterial disease or carotid stenosis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Bone morphogenetic protein 10 and one-year outcomes after open revascularisation in symptomatic peripheral arterial disease or carotid stenosis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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