Soluble urokinase plasminogen activator receptor (su PAR) is a novel, independent predictive marker of myocardial infarction in HIV-1-infected patients: a nested case-control study.

Objectives Patients infected with HIV are at increased risk of myocardial infarction ( MI). Increased plasma levels of the inflammatory biomarker soluble urokinase plasminogen activator receptor (su PAR) have been associated with increased risk of cardiovascular diseases ( CVD), including MI in the general population. We tested su PAR as a predictive biomarker of MI in HIV-1-infected individuals. Methods su PAR levels were investigated in a nested case-control study of 55 HIV-1-infected cases with verified first-time MI and 182 HIV-1-infected controls with no known CVD. Controls were matched for age, gender, duration of antiretroviral therapy ( ART), smoking and no known CVD. su PAR was measured in the four plasma samples available for each patient at different time-points; 1, Before initiation of ART; 2, 3 months after initiation of ART; 3, 1 year before the case's MI; and 4, The last sample available before the case's MI. Results In unadjusted conditional regression analysis, higher levels of su PAR were associated with a significant increase in risk of MI at all time-points. Patients in the third and fourth su PAR quartiles had a three- to 10-fold higher risk of MI compared to patients in the lowest su PAR quartile at all time-points. su PAR remained a strong significant predictor of MI, when adjusting for HIV-1 RNA, total cholesterol, triglycerides and high-density lipoprotein. Conclusion Elevated su PAR levels were associated with increased risk of MI in HIV-infected patients, suggesting that su PAR could be a useful biomarker for prediction of first-time MI in this patient group, even years before the event. [ABSTRACT FROM AUTHOR]