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Background  Type 2 diabetes mellitus is a major risk factor for cardiovascular disease; however, outcomes in individual patients vary. Soluble urokinase plasminogen activator receptor (su PAR ) is a bone marrow–derived signaling molecule associated with adverse cardiovascular and renal outcomes in many populations. We characterized the determinants of su PAR  in African Americans with type 2 diabetes mellitus and assessed whether levels were useful for predicting mortality beyond clinical characteristics, coronary artery calcium ( CAC ), and high‐sensitivity C‐reactive protein (hs‐ CRP ).    Methods and Results  We measured plasma su PAR  levels in 500 African Americans with type 2 diabetes mellitus enrolled in the African American‐Diabetes Heart Study. We used Kaplan‐Meier curves and Cox proportional hazards models adjusting for clinical characteristics,  CAC , and hs‐ CRP  to examine the association between su PAR  and all‐cause mortality. Last, we report the change in C‐statistics comparing the additive values of su PAR , hs‐ CRP , and  CAC  to clinical models for prediction of mortality. The su PAR  levels were independently associated with female sex, smoking, insulin use, decreased kidney function, albuminuria, and  CAC . After a median 6.8‐year follow‐up, a total of 68 deaths (13.6%) were recorded. In a model incorporating su PAR ,  CAC , and hs‐ CRP , only su PAR  was significantly associated with mortality (hazard ratio 2.66, 95% confidence interval 1.63‐4.34). Addition of su PAR  to a baseline clinical model significantly improved the C‐statistic for all‐cause death (Δ0.05, 95% confidence interval 0.01‐0.10), whereas addition of  CAC  or hs‐ CRP  did not.    Conclusions  In African Americans with type 2 diabetes mellitus, su PAR  was strongly associated with mortality and improved risk discrimination metrics beyond traditional risk factors,  CAC  and hs‐ CRP . Studies addressing the clinical usefulness of measuring su PAR  concentrations are warranted.

journal of the american heart association

Predicting Mortality in African Americans With Type 2 Diabetes Mellitus: Soluble Urokinase Plasminogen Activator Receptor, Coronary Artery Calcium, and High‐Sensitivity C‐Reactive Protein