title: Cystatin C concentration as a risk factor for heart failure in older adults.
abstract: BACKGROUND
  Previous studies that evaluated the association of kidney function with incident heart failure may be limited by the insensitivity of serum creatinine concentration for detecting abnormal kidney function.
  
  
  OBJECTIVE
  To compare serum concentrations of cystatin C (a novel marker of kidney function) and creatinine as predictors of incident heart failure.
  
  
  METHODS
  Observational study based on measurement of serum cystatin C from frozen sera obtained at the 1992-1993 visit of the Cardiovascular Health Study. Follow-up occurred every 6 months.
  
  
  METHODS
  Adults 65 years of age or older from 4 communities in the United States.
  
  
  METHODS
  4384 persons without previous heart failure who had measurements of serum cystatin C and serum creatinine.
  
  
  METHODS
  Incident heart failure.
  
  
  RESULTS
  The mean (+/-SD) serum concentrations of cystatin C and creatinine were 82 +/- 25 nmol/L (1.10 +/- 0.33 mg/L) and 89 +/- 34 micromol/L (1.01 +/- 0.39 mg/dL), respectively. During a median follow-up of 8.3 years (maximum, 9.1 years), 763 (17%) participants developed heart failure. After adjustment for demographic factors, traditional and novel cardiovascular risk factors, cardiovascular disease status, and medication use, sequential quintiles of cystatin C concentration were associated with a stepwise increased risk for heart failure in Cox proportional hazards models (hazard ratios, 1.0 [reference], 1.30 [95% CI, 0.96 to 1.75], 1.44 [CI, 1.07 to 1.94], 1.58 [CI, 1.18 to 2.12], and 2.16 [CI, 1.61 to 2.91]). In contrast, quintiles of serum creatinine concentration were not associated with risk for heart failure in adjusted analysis (hazard ratios, 1.0 [reference], 0.77 [CI, 0.59 to 1.01], 0.85 [CI, 0.64 to 1.13], 0.97 [CI, 0.72 to 1.29], and 1.14 [CI, 0.87 to 1.49]).
  
  
  CONCLUSIONS
  The mechanism by which cystatin C concentration predicts risk for heart failure remains unclear.
  
  
  CONCLUSIONS
  The cystatin C concentration is an independent risk factor for heart failure in older adults and appears to provide a better measure of risk assessment than the serum creatinine concentration. *For a full list of participating Cardiovascular Health Study investigators and institutions, see http://www.chs-nhlbi.org.
authors.affiliation: Tufts-New England Medical Center, Boston, Massachusetts, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Catherine O
authors.initials: CO
authors.lastname: Stehman-Breen
authors.forename: Linda F
authors.initials: LF
authors.lastname: Fried
authors.forename: Nancy Swords
authors.initials: NS
authors.lastname: Jenny
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests / Q000379:methods*; D008297:Male; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine