Journal
ATHEROSCLEROSIS
Volume 234, Issue 1, Pages 108-113Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.atherosclerosis.2014.02.020
Keywords
Chronic kidney disease; Risk factors; Mortality; Epidemiology; Atherosclerosis
Funding
- Uppsala-Orebro Regional Research Council (RFR)
- Swedish Research Council [2006-6555, 2012-1727, 2012-2215]
- Swedish Heart-Lung Foundation
- Thureus Foundation
- Marianne and Marcus Wallenberg Foundation, Dalarna University
- Uppsala University
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Objectives: Urinary cystatin C (u-CysC) is a new biomarker for acute tubular kidney dysfunction and may also indicate chronic tubular dysfunction. Chronic kidney disease is an important cardiovascular risk factor, however it is not known if u-CysC is a risk marker for cardiovascular death. Methods: The association between u-CysC and cardiovascular mortality was investigated in a Swedish community-based cohort of 604 men aged 78 years. During follow-up (mean 6.7 years), 203 participants died, of which 90 due to cardiovascular causes. Results: High u-CysC (>0.029 mg/mmol Cr) was associated with a more than 2-fold risk of cardiovascular death (multivariable hazard ratio for quintile 5 vs. 1: 2.5, 95% CI 1.2-5.2, P < 0.05) in Cox regression models independent of cardiovascular risk factors, glomerular filtration rate (eGFR) and urinary Albumin. Participants with low eGFR (<= 60 mL/min), albuminuria (>= 3 mg/mmol Cr) and high u-CysC (>0.029 mg/mmol Cr) combined had a significantly higher cardiovascular mortality risk compared to participants with one or two of these biomarkers normal (hazard ratio 15, 95% CI: 6.7-36, P < 0.001, compared to all three biomarkers normal). Conclusions: This study is the first to show that increased concentrations of the tubular kidney biomarker u-CysC indicated risk of cardiovascular death independently of other cardiovascular risk factors, glomerular filtration and albuminuria. Additional research is needed to further establish the usefulness of u-CysC in clinical practice. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
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