Soluble fas is a marker of coronary artery disease in patients with end-stage renal disease

Coronary artery disease (CAD) is the leading cause of death in patients wit h end-stage renal disease (ESRD). Recent evidence suggests that the express ion of Fas, a molecule implicated in the initiation of apoptosis in various cell types, is increased at sites of atherosclerotic plaques. However, the significance of plasma levels of the soluble form of Fas (sFas) and its li gand (sFas-L) as markers of atherosclerosis has yet to be defined. The pres ent report is a cross-sectional analysis of baseline data from an ongoing p rospective study designed to evaluate the role of sFas and sFas-L as marker s of CAD in ESRD. We evaluated the association between plasma levels of sFa s and sFas-L and evidence of CAD in a cohort of 107 chronic hemodialysis pa tients. Plasma levels of sFas were significantly greater (P = 0.04) among s ubjects with (n = 64) than without evidence of CAD (n = 43). Plasma levels of sFas-L were similar in both groups. Using multivariate analysis, sFas le vel was found to be independently associated with CAD (P = 0.01) after adju stment for classic risk factors for CAD (hyperlipidemia, diabetes, hyperten sion, and smoking), markers of inflammation (C-reactive protein [CRP], inte rcellular adhesion molecule 1), and other confounders. An increase of one q uintile in plasma concentration of sFas was associated with an odds ratio f or CAD of 1.64 (95% confidence interval, 1.11 to 2.41). Models that incorpo rated sFas were significantly better at identifying patients with CAD than models limited to classic risk factors for atherosclerosis, alone (P = 0.00 8) or in combination with CRP levels (P = 0.006). In summary, increased pla sma levels of sFas are associated with CAD in stable patients with ESRD. Th ese results suggest that sFas may represent a novel and independent marker of CAD. (C) 2001 by the National Kidney Foundation, Inc.