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

RATIONALE: Although prostate-specific antigen (PSA), 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 (OR) with 95% confidence intervals (CIs) for prevalent CAC. PSA levels were inversely associated with the presence of CAC. After adjusting for potential confounders, multivariable-adjusted OR (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 less than 4.0 ng/mL, and without known CVD or prostate disease who were followed up with for up to 14 years for CVD mortality (median: 7.3 years). CVD deaths were ascertained through linkage to national death records. Hazard ratios (HRs) 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 HRs (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.