title: Association of cystatin C with mortality, cardiovascular events, and incident heart failure among persons with coronary heart disease: data from the Heart and Soul Study.
abstract: BACKGROUND
  Serum creatinine and related estimating equations predict cardiovascular events and mortality among persons with coronary heart disease (CHD). Cystatin C is a novel and sensitive endogenous marker of kidney function. Whether cystatin C concentrations are associated with adverse events among ambulatory persons with CHD is unknown.
  
  
  RESULTS
  Nine hundred ninety ambulatory persons with CHD were categorized into quartiles of serum cystatin C at inception, with < or = 0.91 mg/L constituting the lowest quartile (I) and > or = 1.30 mg/L constituting the highest (IV). Cox proportional hazards models evaluated time to all-cause mortality, cardiovascular events (composite of CHD death, myocardial infarction, and stroke), and incident heart failure. After a median follow-up of 37 months, 132 participants (13%) died, 101 (10%) had cardiovascular events, and 57 (7%) had incident heart failure. Compared with participants in the lowest cystatin C quartile, those in the highest quartile were at increased risk of all-cause mortality (hazard ratio, 3.6; 95% CI, 1.8 to 7.0), cardiovascular events (hazard ratio, 2.0; 95% CI, 1.0 to 3.8), and incident heart failure (hazard ratio, 2.6; 95% CI, 1.0 to 6.9) in analyses adjusted for traditional cardiovascular risk factors. Cystatin C in the highest quartile predicted similar risk for these outcomes among participants with lower (< or = 60 mL/min per 1.73 m2) or higher estimated glomerular filtration rate and among participants with or without microalbuminuria.
  
  
  CONCLUSIONS
  High cystatin C concentrations predict substantial increased risks of all-cause mortality, cardiovascular events, and incident heart failure among ambulatory persons with CHD. This risk is not completely captured by measures of kidney function routinely used in clinical practice.
authors.affiliation: Division of Nephrology, Department of Medicine, Box 0532, HSE 672, University of California at San Francisco, San Francisco, CA 94143-0532, USA. jix@medicine.ucsf.edu
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ix
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality / Q000523:psychology; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood / Q000401:mortality / Q000523:psychology; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000401:mortality / Q000523:psychology; D006333:Heart Failure / Q000097:blood* / Q000401:mortality* / Q000523:psychology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins