Cystatin C and risk of heart failure in the Physicians' Health Study (PHS) (original) (raw)
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Journal of The American Society of Hypertension, 2009
Serum cystatin C has been associated with cardiovascular disease. We investigated whether cystatin C concentration is associated with the metabolic syndrome and with other cardiovascular risk factors in a hypertensive population. In this cross-sectional study, we prospectively included 611 essential hypertensive patients during a 12-month period. Cystatin C concentration was measured by nephelometry. The metabolic syndrome was present in 46% of the patients. Cystatin C was significantly higher in patients with the metabolic syndrome (0.94 ± 0.27 mg/L) than in those without (0.87 ± 0.23 mg/L) (P < .0001). Pearson partial correlation analysis showed a significant correlation between cystatin C and body mass index (r = 0.240; P = .001); waist circumference (r = 0.173; P = .012); microalbuminuria (r = 0.273; P < .0001); triglycerides (r = 0.138; P = .047); C-reactive protein (r = 0.190; P = .006); uric acid (r = 0.284; P < .0001); age (r = 0.409; P < .0001); and glomerular filtration rate (GFR) (r = -0.638; P < .0001). Multivariate analysis showed that GFR (B = -0.0061; 95% confidence interval [CI], -0.0073 to -0.0049; P < .0001), age (B = 0.0023; 95% CI, 0.0005–0.0041; P = .009), microalbuminuria (B = 0.0005; 95% CI, 0.0002–0.0007; P < .0001), uric acid (B = 0.0252; 95% CI, 0.0085–0.0418; P = .003), body mass index (B = 0.0051, 95% CI, 0.0012–0.0089; P = .011), and C-reactive protein (B = 0.0048; 95% CI, 0.0015–0.0082; P = .005) were independent determinants of cystatin C concentration. Measuring cystatin C concentration in hypertensive patients may be useful for evaluating their cardiovascular risk profile.
Cystatin C as a predictor of cardiovascular outcomes in a hypertensive population
Journal of Human Hypertension, 2017
Calculating the estimated glomerular filtration rate (eGFR) using creatinine-based equations may underestimate cardiovascular risk. Cystatin C-based eGFR may be a stronger prognostic biomarker than creatinine-based eGFR when assessing cardiovascular outcomes and mortality. Our aim was to determine whether levels of serum cystatin C, as an estimator of GFR, had a higher predictive value than creatinine-based eGFR for incident cardiovascular disease among hypertensive patients. We retrospectively analyzed the records of 2016 hypertensive patients from the Hypertension Unit at Mostoles University Hospital between 2006 and 2016. We calculated the eGFR using 3 CKD-EPI equations. The outcomes we included in our study were cardiovascular death, noncardiovascular death, stroke, incident heart failure, and myocardial infarction. We used the Cox regression hazard model to estimate the hazard ratio. Our analysis found that, in terms of cardiovascular morbidity and mortality, both cystatin C-based eGFR (HR 2.88, 95% CI 1.86-4.47, P o 0.0001) showed a higher prognostic value than creatinine-based eGFR (HR 2.83, 95% CI 1.73-4.63, Po 0.0001). In terms of all-cause mortality, cystatin C-based eGFR (HR 4.24, 95% CI 2.38-7.53, P o 0.0001) showed a higher prognostic value than creatinine-based eGFR (HR 2.77, 95% CI 1.43-5.36, P o 0.0001). Our findings suggest that both cystatin C-based eGFRs may be stronger predictors of all-cause mortality and cardiovascular events in our hypertensive cohort when compared to creatinine-based eGFR, and may improve the risk assessment in certain populations.
Journal of Cardiology, 2013
The association of cystatin C with renal function has been studied for more than 25 years. Cystatin C has been described to have a better diagnostic performance than creatinine to assess renal function, particularly to detect small reductions in glomerular filtration rate. Recently, cystatin C has emerged as a strong predictor of incident or recurrent cardiovascular events and adverse outcomes in patients without kidney disease. Furthermore, it has been suggested that cystatin C concentrations are directly related to both inflammation and atherosclerosis. Nevertheless, the link between inflammation, atherogenesis, cardiovascular risk, and cystatin C is still poorly understood. This brief report discusses recent data, contrasting findings and possible mechanisms involved in this interaction.
The American Journal of Cardiology, 2008
Previous studies indicated that serum cystatin C, a marker of renal function, was associated with cardiovascular disease (CVD). However, few data about this association are available for persons without chronic kidney disease or albuminuria. Data from 4,991 subjects in the Third National Health and Nutrition Examination Survey with an estimated glomerular filtration rate >60 ml/min/1.73 m 2 without micro-or macroalbuminuria were analyzed. Subjects were categorized into quartiles of serum cystatin C and compared for prevalence of CVD. CVD was defined as a history of myocardial infarction, angina, or stroke. After age standardization, prevalences of CVD from the lowest to highest quartile of serum cystatin C were 6.0%, 8.8%, 11.8%, and 16.7% (p-trend ؍ 0.006). Also, age-standardized prevalences of myocardial infarction across quartiles of serum cystatin C were 1.9%, 4.4%, 6.6%, and 8.6%; age-standardized prevalences of angina were 2.4%, 4.4%, 4.2%, and 7.1%; and age-standardized prevalences of stroke were 2.5%, 1.6%, 3.5%, and 4.4% (each p-trend <0.05). Each 1-SD higher serum cystatin C level was associated with a multivariate prevalence ratio of CVD of 1.55 (95% confidence interval [CI] 1.13 to 2.13), and multivariate-adjusted prevalence ratios were 1.44 (95% CI 1.01 to 2.07), 1.64 (95% CI 1.02 to 2.64), and 1.65 (95% CI 1.06 to 2.56) for myocardial infarction, angina, and stroke, respectively. In conclusion, a graded association exists between higher serum cystatin C and increased CVD prevalence in patients without established chronic kidney disease.
Background: Renal impairment (RI) is associated with worse prognosis. Recently, cystatin C has been shown to represent a potentially superior marker of the glomerular filtration rate compared with creatinine clearance (CrCl). We evaluated the impact of cystatin C and other markers of RI on prognosis in a large cohort of patients with coronary heart disease (CHD). Methods: Cystatin C, creatinine (Cr), and CrCl were determined at baseline in a cohort of 1033 patients (30 -70 years) with CHD. Patients were followed for a mean of 33.5 months, and a combined endpoint [fatal and nonfatal cardiovascular disease (CVD) events] was used as the outcome variable. Cystatin C was measured by immunonephelometry, and CrCl was calculated. Results: During follow-up, 71 patients (6.9%) experienced a secondary CVD event. Neither Cr (P ؍ 0.63) nor CrCl (P ؍ 0.10) were associated with incidence of CVD events, whereas cystatin C was clearly associated with risk of secondary CVD events (P <0.0001). In multivariate analyses, patients in the top quintile of the cystatin C distribution at baseline had a statistically significantly increased risk of secondary CVD events even after adjustment for classic risk factors, severity of coronary disease, history of diabetes mellitus, treatment with angiotensin-converting enzyme inhibitors, and Creactive protein (hazard ratio, 2.27; 95% confidence in-terval, 1.05-4.91) compared with patients in the bottom quintile. Conclusions: These data support the possibly important prognostic value of cystatin C among patients with known CHD and suggest that it may be a useful clinical marker providing complementary information to established risk determinants.
International Journal of Nephrology, 2014
Background. We examine whether cystatin C, a surrogate marker of renal function, could identify patients with chronic kidney disease (CKD) with an increased risk of renal disease progression, death, or cardiovascular events. Methods. Data were obtained for 180 patients, with a diagnosis of chronic renal failure based on serum creatinine estimated glomerular filtration rate (eGFR creat) <90 mL/min/1.73 m 2. This population was grouped in tertiles according to cystatin C and creatinine values at baseline. Cardiovascular events and overall mortality were estimated for each tertile. Predictors of overall mortality and for the development of renal disease progression were analyzed. Results. The median age was 75 years (interquartile range 69-82) and the median eGFR creat 38 mL/min m 2 (interquartile range 33-49). Overall mortality was lower on the first and on the second tertiles of cystatin C than on the third one (HR = 0.060; 95% CI: 0.008-0.447 and HR = 0.094; 95% CI: 0.022-0.406, resp.). Deaths related to the creatinine tertiles followed the same pattern, but differences were not as large. Cardiovascular mortality was lower on the second than on the third cystatin C tertile (HR = 0.198; 95% CI: 0.040-0.987), but it did not show differences on the first and the second creatinine tertiles compared with the third one (HR = 0.126; 95% CI: 0.013-1.265 and HR = 0.403; 95% CI: 0.093-1.740). The only independent predictors of mortality during followup were baseline cystatin C (OR = 0.100; 95% CI: 0.021-0.463) and baseline uric acid (OR = 1.377; 95% CI: 1.070-1.773). Conclusion. Cystatin C may be an alternative to creatinine for detecting a high risk of death and cardiovascular events in a population with CKD.
Cystatin C as the Predictor of Chronic Kidney Disease in Patients with Comorbid Pathology
Iris Publsihers LLC, 2019
Purpose of the study: To study the content of cystatin C and to identify the factors reducing the glomerular filtration rate in patients with comorbid pathology. Materials and methods: 383 patients with comorbid pathology aged from 25 to 88 years (mean age 58.8±12.0 years) were examined, of whom 51.4% were men and 48.6% women. In the structure of comorbid pathology, arterial hypertension (AH) was observed in 76.5%, coronary heart disease (CHD) in 48.8%, diabetes mellitus (DM) type2 in 29.7%, obesity in 47, 5% and chronic obstructive pulmonary disease (COPD) in 28.9% of patients. The examined patients were divided into 4 groups: 1 st persons with hypertension+type2 diabetes (n = 99); 2 nd-AH + CHD (n = 138); 3 rd-AH + COPD (n = 102) and the 4 th group patients with severe comorbid pathology, i.e. AH + DM + CHD + COPD (n = 44). All patients were studied for lipid spectrum parameters [total cholesterol (cholesterol), high-density lipoprotein cholesterol (HDL cholesterol), low-density lipoprotein cholesterol (LDL cholesterol), triglycerides (TG)] and cystatin C of blood plasma. The glomerular filtration rate (GFR) was calculated according to the formula F.J. Hoek. The severity of renal dysfunction was assessed according to the recommendation of KDIGO (Kidney Disease: Improving Global Outcomes) 2012. The analysis of the prevalence of reduced GFR in patients with comorbid pathology was also carried out. Results: The presence of reduced GFR gradations of C2 and C3 "A" was detected in 46.7% and 24.8% of the examined individuals, respectively. Severe reduction in GFR was observed in 11.7% of patients. Sharply reduced GFR (C4 gradation) was significantly more frequently registered in women than in men (10.7% versus 5.0%; p <0.05). In the examined cohort, persons of middle and old age made up 36.8% and 42.2%, respectively. In patients with comorbid pathology, cases of hypercholesterolemia (41.7%), hypertriglyceridemia (45.4%) and elevated levels of LDL cholesterol (46.9%) were frequently detected, and in the 4 th group, the mean age and body mass index (BMI) were significantly higher, and cholesterol levels of HDL and GFR were significantly lower compared with other groups. In the 1st group (AH+DM type2), systolic blood pressure (SBP), total cholesterol and cystatin C plasma levels were significantly higher than in the AH+CHD, AH+COPD groups and patients with severe comorbid pathologies. Higher concentrations of LDL cholesterol were observed in patients with hypertension and COPD. In the 1 st group of patients, the GFR value closely correlated with age (r=-0.21; p=0.03), the level of SBP (r=-0.34; p=0.03), and concentration cystatin C of blood plasma (r=-0.87; p=0.01). In the 2 nd subgroup, the GFR index was associated with the level of the SBP (r=-0.32; p=0.03) and the concentration of cystatin C in the blood plasma (r=-0.86; p=0.03). In patients with AH, COPD negative association of GFR was recorded with age (r=-0.44; p=0.03), heart rate (r=-0.36; p=0.03), total cholesterol concentration (r=-0.20; p=0.04), HDL cholesterol levels (r=-0.27; p=0.03), LDL cholesterol levels (r=-0.27; p=0.03), as well as cystatin C (r=-0.89; p=0.01). In the 4 th subgroup, the magnitude of GFR was significantly correlated with the level of SAP (r=-0.33; p=0.03) and the concentration of cystatin C of blood plasma (r =-0.86; p=0.01). Findings: In patients with comorbid pathology, the frequency of reduction in glomerular filtration rate of the C2 gradation was 46.7%, and the C3 "A" gradation was 24.8%. Severe decline in renal function was observed in 11.7% of patients, and it was more often detected in women. In comorbid pathology, a decrease in renal function is associated with the presence of hypercholesterolemia, hypertriglyceridemia, and an elevated level of cholesterol of low-density lipoprotein. In individuals with comorbid pathology, the incidence and severity of chronic kidney disease are influenced by age, body mass index, systolic blood pressure, total cholesterol and cystatin C concentrations of blood plasma.
Cystatin C concentration as a predictor of systolic and diastolic heart failure
2008
Background-Risk factors for heart failure (HF) may differ according to ejection fraction (EF). Higher cystatin C, a marker of kidney dysfunction, is associated with incident HF, but prior studies did not determine EF at diagnosis. We hypothesized that kidney dysfunction would predict diastolic HF (DHF) better than systolic HF (SHF) in the Cardiovascular Health Study.
Nephrology Dialysis Transplantation, 2012
Background. Glomerular filtration rate <60 mL/min/1.73m 2 is associated with increased cardiovascular risk. Cystatin C is believed to be a better tool than creatinine for detection of mild renal dysfunction (>60 mL/min/1.73m 2 ) and possibly a more sensitive marker for cardiovascular risk and all-cause mortality. We examined the association of cystatin C with cardiovascular morbidity and all-cause mortality in a prospective population-based study.