Journal
ATHEROSCLEROSIS
Volume 229, Issue 2, Pages 541-548Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.atherosclerosis.2013.04.027
Keywords
Cystatin C; Renal function; eGFR; Mortality; Coronary artery disease
Funding
- 6th Framework Program of the European Union [LSHM-CT-2004-503485]
- 7th of Framework Program of the European Union [201668]
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Aims: Cystatin C is a well established marker of kidney function. There is evidence that cystatin C concentrations are also associated with mortality. The present analysis prospectively evaluated the associations of cystatin C with all-cause and cardiovascular (CV) mortality in a well-characterized cohort of persons undergoing angiography, but without overt renal insufficiency. Methods: Cystatin C was available in 2998 persons (mean age: 62.7 +/- 10.5 years; 30.3% women). Of those 2346 suffered from coronary artery disease (CAD) and 652 (controls) did not. Creatinine (mean +/- SD: 83.1 +/- 47.8 vs. 74.1 +/- 24.7 mmol/L, p = 0.036) but not Cystatin C (mean +/- SD: 1.02 +/- 0.44 vs. 0.92 +/- 0.26 mg/L, p = 0.065) was significantly higher in patients with CAD. After a median follow-up of 9.9 years, in total 898 (30%) deaths occurred, 554 (18.5%) due to CV disease and 326 (10.9%) due to non-CV causes. Multivariable-adjusted Cox analysis (adjusting for eGFR and established cardiovascular risk factors, lipid lowering therapy, angiographic coronary artery disease, and C-reactive protein) revealed that patients in the highest cystatin C quartile were at an increased risk for all-cause (hazard ratio (HR) 1.93, 95% CI 1.50-2.48) and CV mortality (HR 2.05 95% CI 1.48-2.84) compared to those in the lowest quartile. The addition of cystatin C to a model consisting of established cardiovascular risk factors increased the area under the receiver-operating characteristic curve for CV and all-cause mortality, but the difference was statistically not significant. However, reclassification analysis revealed significant improvement by addition of cystatin C for CV and all-cause mortality (p < 0.001), respectively. Conclusion: The concentration of cystatin C is strongly associated with long-term all-cause and cardiovascular mortality in patients referred to coronary angiography, irrespective of creatinine-based renal function. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
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