title: Soluble urokinase plasminogen activator receptor: a risk factor for carotid plaque, stroke, and coronary artery disease.
abstract: OBJECTIVE
  Recent studies indicate that the urokinase system could have an important role in atherogenesis and plaque rupture. The relationships among the soluble urokinase plasminogen activator receptor (suPAR), carotid plaque, and incidence of ischemic stroke and coronary artery disease (CAD) events were studied in a prospective cohort.
  
  
  METHODS
  Occurrence of carotid plaque and plasma levels of suPAR were assessed in 5166 men and women, aged 45 to 68 years, participating in the Malmö Diet and Cancer study. Incidences of ischemic stroke and CAD were monitored during a mean follow-up of 15 years.
  
  
  RESULTS
  Subjects with carotid plaque had significantly higher levels of suPAR compared with those without carotid plaque. suPAR was associated with increased incidence of ischemic stroke (hazard ratio [HR] for third versus first tertile, 1.50; 95% confidence interval [CI], 1.06-2.11) and CAD (HR, 1.55; 95% CI, 1.13-2.13) after adjustment for risk factors. The risk factor-adjusted HR for ischemic stroke was 2.21 (95% CI, 1.52-3.22) in subjects with carotid plaque and high suPAR (ie, third tertile) and 1.51 (95% CI, 1.05-2.17) in subjects with carotid plaque and low suPAR compared with those without carotid plaque and low suPAR (reference). High levels of suPAR significantly increased the risk of ischemic stroke and CAD in subjects with carotid plaque.
  
  
  CONCLUSIONS
  suPAR is associated with increased occurrence of carotid plaque and increased incidence of ischemic stroke and CAD. Presence of both elevated levels of suPAR and carotid plaque increases the risk of ischemic stroke in an additive way.
authors.affiliation: From the Clinical Research Unit, Medicine, Skåne University Hospital Malmö, Malmö, Sweden (M.P., G.Ö., O.M.); and Department of Clinical Sciences Malmö, Lund University, Lund, Sweden (M.P., G.Ö., G.S., V.H., O.M., B.H., G.E.).
authors.forename: Margaretha
authors.initials: M
authors.lastname: Persson
authors.forename: Gerd
authors.initials: G
authors.lastname: Östling
authors.forename: Gustav
authors.initials: G
authors.lastname: Smith
authors.forename: Viktor
authors.initials: V
authors.lastname: Hamrefors
authors.forename: Olle
authors.initials: O
authors.lastname: Melander
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
mesh_terms: D000368:Aged; D015415:Biomarkers; D002545:Brain Ischemia / Q000453:epidemiology / Q000235:genetics / Q000378:metabolism; D002340:Carotid Artery Diseases / Q000453:epidemiology* / Q000235:genetics* / Q000378:metabolism; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000235:genetics* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000453:epidemiology* / Q000235:genetics* / Q000378:metabolism; D011153:Population; D011446:Prospective Studies; D055293:Receptors, Urokinase Plasminogen Activator / Q000235:genetics* / Q000378:metabolism*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000235:genetics* / Q000378:metabolism; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D055293:Receptors, Urokinase Plasminogen Activator
keywords: carotid artery plaque; coronary artery disease