Association of Urinary Prostaglandin E2 Metabolite and Mortality among Adults

Abstract Background Prostaglandins play a critical role in inflammatory response. It has become widely accepted that chronic inflammation is a driving force behind many chronic diseases, such as cancers and cardiovascular diseases, the major causes of death in the world today. The studies on the association between biomarkers of inflammation and mortality are limited. Methods To investigate the association of urinary PGE-M, a stable end-product of prostaglandin E2 (PGE2) with overall and cause-specific mortality and examine potential effect modifiers, we obtained urinary PGE-M levels of 2,927 non-cancerous adults from our previous case-control studies nested in the Shanghai Women’s Health Study and Shanghai Men’s Health Study, two cohort studies conducted in Shanghai, China. We collected mortality data and modifiable factors associated with urinary PGE-M were obtained from the parent cohort studies. Results Using linear regression models, we found that high urinary PGE-M levels were significantly associated with low education, heaving smoking, old age at urine collection, and abdominal obesity. Using Cox proportional hazards models, we found that increase (per standard deviation) of urinary PGE-M levels were significantly associated with overall mortality (adjusted hazard ratio = 1.19, 95% confidence interval: 1.07, 1.33) and particularly deaths from cardiometabolic diseases (adjusted hazard ratio = 1.27, 95% confidence interval: 1.11, 1.44). The increased death risks persisted across different time intervals during the follow-up and were stronger among participants who were younger than 60 (P = 0.0014 for all- cause mortality and P = 0.007 for deaths from cardiometabolic diseases) at urine collection or perhaps among those who had higher education. Conclusions High urinary PGE-M levels were associated with a significantly increased risk of all causes of death and particularly deaths from cardiometabolic diseases. Improving lifestyles, e.g., stopping smoking and controlling body weight, would help decrease mortality through decreasing over-production of PGE2.