Prognostic value of suPAR and hs-CRP on cardiovascular disease

Studies have shown that soluble urokinase Plasminogen Activator Receptor (suPAR) and CRP (both inflammatory markers) and coronary artery calcification (CAC) are independent risk predictors for cardiovascular (CV) disease. The aim of this study is to assess whether suPAR and CRP have an increased predictive prognostic value beyond the traditional CV risk factors and the CAC score. A population sample of 1179 subjects, free of CV disease was included. The subjects underwent traditional CV risk evaluation, CAC assessment and blood sampling for suPAR and CRP. CV events were extracted from The Danish National Patient Register after 6.5 years. The additive values of suPAR and CRP were evaluated by unadjusted Kaplan Meier analysis, adjusted hazard ratio and ROCAUC models. 1179 participants (47.6% males, mean age 55 years) were included. 73 events occurred. In Kaplan Meier analyses, suPAR and CRP were significantly associated with CV events (p = 0.03 and p = 0.002). Adjusted for the CV risk factors and the CAC score, the hazard ratios for suPAR and CRP were 1.17 (95% confidence interval [CI] 1.01–1.34) and 1.04 (95% CI 1.01–1.06), respectively. suPAR was associated with a substantial risk among women (2.03; 95% CI 1.45–2.84) and 60-year-old subjects (1.44; 95% CI 1.09–1.90). By ROCAUC, neither suPAR nor CRP provided significant estimates (0.7100 and 0.7054) compared to the traditionally CV risk factors (0.6952, p = 0.24 and p = 0.16) and CAC score (0.7481, p = 0.33 and p = 0.32). Adjusted for traditional CV risk factors and CAC score, suPAR and CRP were of minor importance in risk prediction. •In adjusted Cox analysis, suPAR and CRP were significantly associated with cardiovascular events.•suPAR was particular promising among women and persons at age 60.•CPR was of importance among persons at age 60.•Neither suPAR nor CRP improved area under the curve in the entire population.•Inflammatory markers may supplement risk stratification after adjustment for CAC.