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

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

Chang Y1,2,3, Kim JH4, Noh JW5,6, Cho YS7, Park HJ7, Joo KJ7, Ryu S1,2,3.

Author information

1
From the Center for Cohort Studies, Total Healthcare Center (Y.C., S.R.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
2
Department of Occupational and Environmental Medicine (Y.C., S.R.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
3
Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea (Y.C., S.R.).
4
Department of Urology, and Urological Biomedicine Research Institute, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea (J.H.K).
5
Department of Healthcare Management, Eulji University, Seongnam, Republic of Korea (J.-W.N.).
6
Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, the Netherlands (J.-W.N.).
7
Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea (Y.-S.C., H.J.P., K.J.J.).

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

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