Abstract 17717: Association of Depression with Soluble Urokinase- Type Plasminogen Activator Receptor and Other Markers of Inflammation and Immunity

Abstract

Background: Depression, coronary artery disease (CAD), and inflammation may share pathophysiological links. Soluble urokinase-type plasminogen activator receptor (suPAR) is a biomarker of inflammatory and immune function activation that has been associated with many chronic inflammatory disorders including cardiovascular diseases. Whether suPAR is related to depression has not been evaluated before.

METHODS: 2688 patients, aged 63+/-12, 65% male, undergoing cardiac catheterization (60% with significant CAD defined as ≥50% stenosis in at least one coronary) were enrolled in the Emory Cardiovascular BioBank. Depression was measured using the Patient Health Questionnaire-9 and analyzed as a continuous score (range 0-27) and as a dichotomous variable with a score ≥10 being indicative of depression. Log-transformed suPAR was modeled by linear regression adjusting for demographic factors, traditional risk factors, medical history, presence and severity of CAD, and CRP levels. Results: Depressed patients (n= 1135) were younger, more often female (46% vs. 34%), hypertensive (77% vs. 71%), smokers (65% vs. 58%), and more often had a history of MI (35% vs. 29%), heart failure (23% vs. 16%), stroke (12% vs. 8%), and PVD (18% vs. 13%), p<0.01 for all. Compared to patients without depression, patients with depression had 18% higher level of suPAR (p<0.001) in unadjusted analysis, and 11% higher level of suPAR after adjusting for demographic factors, traditional risk factors, medical history, presence and severity of CAD and CRP (p<0.001). For each 5 point increase in PHQ9, the level of suPAR increased by 7.7% (p<.001) in unadjusted analysis, and by 4.6% (p<.001) after adjusting for the same factors mentioned above. Results were similar in subjects with and without significant CAD. Conclusion- suPAR levels, a biomarker indicative of inflammation and immune activation, are elevated in patients with suspected or established CAD who have depression, and this association is independent of CAD severity, risk factors, comorbidities and CRP.