Abstract 16154: Soluble Urokinase Plasminogen Activator Receptor (suPAR) is Associated with Presence and Severity of Coronary Disease and is an Independent Predictor of Adverse Cardiovascular Outcomes
Introduction: Soluble urokinase plasminogen activator receptor (suPAR) is an emerging inflammatory and immune biomarker. Recent studies have demonstrated a positive association of suPAR with incident cardiovascular (CV) disease. No studies have yet examined suPAR’s role in individuals at high risk for or with established CV disease or its association with presence or severity of coronary artery disease (CAD).
Methods: 3,367 individuals (64% with significant CAD defined as ≥50% stenosis in ≥1 artery on angiography) from the Emory Cardiovascular Biobank were analyzed and followed for adverse CV outcomes of death and myocardial infarction (MI) over a mean 2.1 ± 1.1 years. Plasma suPAR levels were measured using ELISA. Quantitative angiographic scoring using the Gensini score was also performed. Cox proportional hazard survival analyses and C-statistic were performed with models adjusted for established CV risk factors, CRP levels and CAD severity indices. Data were analyzed as continuous variables and with a cut point calculated using Youden’s index from the ROC curve.
Results: The cutoff that maximized Youden's index for suPAR was 3.5 ng/ml. Hazard Ratios (HR) for outcomes of death and MI was 2.1 (p<0.0001) using the cutoff. Analyzed as a continuous variable, for each doubling of suPAR levels, the HR increased by 2.3 (p<0.0001). The C-statistic for a model based on traditional risk factors was 0.696. With the addition of suPAR using the cutoff, the model improved to 0.731 (p<0.0001). Low levels of suPAR was an independent predictor of an angiographically normal cath (p<0.05). suPAR was also an independent predictor of severity of CAD using Gensini and binary scoring when analyzed as a continuous variable and using the cutpoint (p<0.05 for all).
Conclusion: suPAR is a novel biomarker that is associated with presence and severity of CAD. Furthermore, levels of suPAR are an independent predictor of death and MI in patients at high risk for or with established CAD.
- © 2012 by American Heart Association, Inc.