REN and endothelial dysfunction: However, previous research has illustrated a deleterious effect of OPG on CVD by enhancing the adherence of leucocytes to the endothelial surface, the activation of the renin–angiotensin system (RAS), pro-inflammatory and pro-fibrotic effects, and the induction of endothelial dysfunction in the early stages of atherogenesis (Dutka et al., 2022).