Plasma concentrations of cystatin C in patients with coronary heart disease and risk for secondary cardiovascular events: more than simply a marker of glomerular filtration rate.
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 C-reactive protein (hazard ratio, 2.27; 95% confidence interval, 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.
Koenig
Wolfgang
W
Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany. wolfgang.koenig@medizin.uni-ulm.de
Twardella
Dorothee
D
Brenner
Hermann
H
Rothenbacher
Dietrich
D
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis*; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012306:Risk; D012307:Risk Factors
D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine