Shani Botha1, Carla M T Fourie2, Rudolph Schutte3, Jesper Eugen-Olsen4, Ronel Pretorius5, Aletta E Schutte3. 1. Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa. Electronic address: shani.botha@nwu.ac.za. 2. Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa. 3. Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; Medical Research Council, Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa. 4. Clinical Research Centre 136, Copenhagen University Hospital, Hvidovre, Denmark. 5. Research to Advance Quality of Nursing & Midwifery (INSINQ), North-West University, Potchefstroom, South Africa.
Abstract
BACKGROUND: Elevated inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) are well-known risk factors for cardiovascular mortality. The less familiar marker, soluble urokinase plasminogen activator receptor (suPAR), is known to predict cancer, infections and all-cause mortality. We determined whether suPAR, CRP and IL-6 are predictive of both all-cause and cardiovascular mortality in a black population, highly burdened by cardiovascular disease and HIV infection. METHODS: We included 1425 black South Africans, of which 208 died within five years after baseline data collection. EDTA plasma biomarker levels were determined, while all-cause and cardiovascular mortality were used as endpoints. RESULTS: At baseline suPAR, CRP and IL-6 were higher in non-survivors than in survivors (P<0.001). SuPAR (HR 1.27, 95% CI 1.09-1.48), IL-6 (HR 1.49, 95% CI 1.24-1.78) and CRP (HR 1.39, 95% CI 1.17-1.65) predicted all-cause mortality, while only suPAR (HR 1.40, 95% CI 1.04-1.87) and IL-6 (HR 1.61, 95% CI 1.10-2.35) predicted cardiovascular mortality. The prognostic value of suPAR was independent of IL-6 and CRP (P≤0.015). CONCLUSION: SuPAR predicted both all-cause and cardiovascular mortality, independent of traditional risk factors, HIV and other inflammatory markers, underlining the prognostic value of suPAR in a black population.
BACKGROUND: Elevated inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) are well-known risk factors for cardiovascular mortality. The less familiar marker, soluble urokinase plasminogen activator receptor (suPAR), is known to predict cancer, infections and all-cause mortality. We determined whether suPAR, CRP and IL-6 are predictive of both all-cause and cardiovascular mortality in a black population, highly burdened by cardiovascular disease and HIV infection. METHODS: We included 1425 black South Africans, of which 208 died within five years after baseline data collection. EDTA plasma biomarker levels were determined, while all-cause and cardiovascular mortality were used as endpoints. RESULTS: At baseline suPAR, CRP and IL-6 were higher in non-survivors than in survivors (P<0.001). SuPAR (HR 1.27, 95% CI 1.09-1.48), IL-6 (HR 1.49, 95% CI 1.24-1.78) and CRP (HR 1.39, 95% CI 1.17-1.65) predicted all-cause mortality, while only suPAR (HR 1.40, 95% CI 1.04-1.87) and IL-6 (HR 1.61, 95% CI 1.10-2.35) predicted cardiovascular mortality. The prognostic value of suPAR was independent of IL-6 and CRP (P≤0.015). CONCLUSION:SuPAR predicted both all-cause and cardiovascular mortality, independent of traditional risk factors, HIV and other inflammatory markers, underlining the prognostic value of suPAR in a black population.
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