Circulating surfactant protein-D and the risk of cardiovascular morbidity and mortality

Eur Heart J. 2011 Aug;32(15):1918-25. doi: 10.1093/eurheartj/ehr124. Epub 2011 Jun 8.


Aims: Surfactant protein-D (SP-D) is a lung-specific protein that is detectable in human plasma. We determined the relationship of circulating SP-D to cardiovascular disease (CVD) and total mortality in subjects with and without CVD.

Methods and results: Plasma SP-D levels were measured in 806 patients who underwent coronary angiography to assess its predictive value for cardiovascular mortality. Serum SP-D levels were also measured in a replication cohort to assess its relationship with CVD events in 4468 ex- and current smokers without a known history of coronary artery disease (CAD). Patients who died during follow-up had significantly higher plasma SP-D levels than those who survived (median 85.4 vs. 64.8 ng/mL; P < 0.0001). Those in the highest quintile of SP-D had 4.4-fold higher risk of CVD mortality than those in the lowest quintile (P < 0.0001) independent of age, sex, and plasma lipid levels. In a group of current and ex-smokers without a known history of CAD, serum SP-D levels were elevated in those who died or were hospitalized for CVD compared with those who did not (median 99.8 vs. 90.6 ng/mL; P = 0.0001).

Conclusion: Circulating SP-D is a good predictor of cardiovascular morbidity and mortality and adds prognostic information to well-established risk factors such as age, sex, and plasma lipids and is a promising biomarker to link lung inflammation/injury to CVD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / blood
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / mortality*
  • Chronic Disease
  • Cohort Studies
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Interleukin-6 / metabolism
  • Male
  • Middle Aged
  • Pneumonia / blood
  • Pneumonia / mortality
  • Prognosis
  • Pulmonary Surfactant-Associated Protein D / blood*
  • ROC Curve
  • Risk Factors


  • Biomarkers
  • Interleukin-6
  • Pulmonary Surfactant-Associated Protein D