A Narrative Review of the Prognostic Value of Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) in Cardiovascular Disease.

The soluble urokinase-type plasminogen activator receptor (suPAR) is a promising biomarker associated with various clinical entities. This review considers the association between suPAR and cardiovascular (CV) disease (CVD). We conducted a comprehensive electronic search of the literature on suPAR and CVD. PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were searched from inception to December 31, 2025. Raised suPAR levels are independently associated with atherosclerosis, coronary artery disease, myocardial infarction, peripheral arterial disease (PAD) and related events and overall CV mortality. suPAR reflects inflammatory pathways distinct from those captured by C-reactive protein and is less affected by anthropometric parameters. suPAR levels correlate with endothelial dysfunction, the severity and extent of PAD and coronary artery calcium score, plaque inflammation and neointima hyperplasia. The variant rs4760 of the Plasminogen Activator, Urokinase Receptor gene that encodes suPAR may promote atherosclerosis. Lifestyle interventions and pharmacologic therapies may reduce suPAR levels. suPAR represents a robust biomarker with the potential to enhance personalized management of CVD. Despite strong evidence supporting its prognostic value, the clinical integration of suPAR remains limited. Future research should investigate its utility in risk stratification, monitoring of therapeutic response, and perioperative CV risk assessment.