Open AccessSoluble Urokinase Plasminogen Activator Receptor Level Is an Independent Predictor of the Presence and Severity of Coronary Artery Disease and of Future Adverse Events
Author(s) -
Eapen Danny J.,
Manocha Pankaj,
Ghasemzadeh Nima,
Patel Riyaz S.,
Al Kassem Hatem,
Hammadah Muhammad,
Veledar Emir,
Le NgocAnh,
Pielak Tomasz,
Thorball Christian W.,
Velegraki Aristea,
Kremastinos Dimitrios T.,
Lerakis Stamatios,
Sperling Laurence,
Quyyumi Arshed A.
Publication year - 2014
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.114.001118
Subject(s) - medicine , supar , cardiology , coronary artery disease , hazard ratio , myocardial infarction , biomarker , plasminogen activator , urokinase receptor , confidence interval , biochemistry , chemistry
Soluble urokinase plasminogen activator receptor (suPAR) is an emerging inflammatory and immune biomarker. Whether suPAR level predicts the presence and the severity of coronary artery disease (CAD), and of incident death and myocardial infarction (MI) in subjects with suspected CAD, is unknown. Methods and Results We measured plasma suPAR levels in 3367 subjects (67% with CAD) recruited in the Emory Cardiovascular Biobank and followed them for adverse cardiovascular (CV) outcomes of death and MI over a mean 2.1±1.1 years. Presence of angiographic CAD (≥50% stenosis in ≥1 coronary artery) and its severity were quantitated using the Gensini score. Cox's proportional hazard survival and discrimination analyses were performed with models adjusted for established CV risk factors and C‐reactive protein levels. Elevated suPAR levels were independently associated with the presence of CAD ( P <0.0001) and its severity ( P <0.0001). A plasma suPAR level ≥3.5 ng/mL (cutoff by Youden's index) predicted future risk of MI (hazard ratio [HR]=3.2; P <0.0001), cardiac death (HR=2.62; P <0.0001), and the combined endpoint of death and MI (HR=1.9; P <0.0001), even after adjustment of covariates. The C‐statistic for a model based on traditional risk factors was improved from 0.72 to 0.74 ( P =0.008) with the addition of suPAR. Conclusion Elevated levels of plasma suPAR are associated with the presence and severity of CAD and are independent predictors of death and MI in patients with suspected or known CAD.