Prostate-Specific Antigen Within the Reference Range, Subclinical Coronary Atherosclerosis, and Cardiovascular Mortality

Circ Res. 2019 May 10;124(10):1492-1504. doi: 10.1161/CIRCRESAHA.118.313413.

Abstract

Rationale: Although PSA (prostate-specific antigen)-a tumor marker for prostate cancer-has been reported to be associated with cardiovascular disease (CVD) risk factors, studies on the association of PSA with subclinical and clinical CVD remain limited.

Objective: We examined the association of total serum PSA within the reference range with coronary artery calcium (CAC) score and CVD mortality.

Methods and results: A cross-sectional study was performed in 88 203 Korean men who underwent a health checkup exam including cardiac tomography estimation of CAC score. Logistic regression model was used to calculate odds ratios with 95% CIs for prevalent CAC. PSA levels were inversely associated with the presence of CAC. After adjusting for potential confounders, multivariable-adjusted odds ratio (95% CIs) for prevalent CAC comparing PSA quartiles 2, 3, and 4 to the first quartile were 0.96 (0.90-1.01), 0.88 (0.83-0.93), and 0.85 (0.80-0.90), respectively ( P for trend, <0.001). A cohort study was performed in 243 435 Korean men with a mean age of 39.3 years, PSA values of <4.0 ng/mL, and without known CVD or prostate disease who were followed up with for ≤14 years for CVD mortality (median, 7.3 years). CVD deaths were ascertained through linkage to national death records. Hazard ratios and 95% CIs for CVD mortality were estimated using Cox proportional hazards regression analyses. During 1 829 070.1 person-years of follow-up, 336 CVD deaths were identified. After adjustment for potential confounders, multivariable-adjusted hazard ratios (95% CIs) for CVD mortality comparing PSA quartiles 2, 3, and 4 to the lowest quartile were 0.90 (0.66-1.22), 0.79 (0.58-1.08), and 0.69 (0.51-0.93), respectively.

Conclusions: Serum total PSA levels within the reference range showed an inverse association with subclinical atherosclerosis and CVD mortality in young and middle-aged Korean men, indicating a possible role of PSA as a predictive marker for subclinical and clinical CVD.

Keywords: atherosclerosis; cardiovascular diseases; cohort studies; middle aged; prostate-specific antigen.

MeSH terms

  • Adult
  • Atherosclerosis / blood*
  • Atherosclerosis / mortality
  • Cardiovascular Diseases / mortality
  • Confidence Intervals
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / mortality
  • Cross-Sectional Studies
  • Humans
  • Kallikreins / blood*
  • Male
  • Middle Aged
  • Odds Ratio
  • Prostate-Specific Antigen / blood*
  • Prostatic Neoplasms / blood
  • Reference Values
  • Regression Analysis
  • Republic of Korea / epidemiology
  • Vascular Calcification / blood*
  • Vascular Calcification / mortality

Substances

  • KLK3 protein, human
  • Kallikreins
  • Prostate-Specific Antigen