title: Relations between markers of renal function, coronary risk factors and the occurrence and severity of coronary artery disease.
abstract: OBJECTIVE
  While renal failure greatly increases coronary risk, mild renal impairment is not usually considered a major risk factor. To explore this we assessed relations between measures of mild impairment of renal function and coronary artery disease (CAD) together with other risk factors.
  
  
  RESULTS
  In 408 consecutive patients aged 75 years or less with angiographically defined normal or obstructed coronary arteries and an estimated glomerular filtration rate (eGFR) >45 mL/min per 1.73 m(2), we assessed relations between severity of CAD and levels of plasma cystatin C, creatinine, eGFR, lipid profile, C-reactive protein (CRP), homocysteine, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA). With univariate ANOVA, the severity of CAD was significantly associated with all indices of renal function: increased plasma cystatin C (p=0.003) and creatinine (p=0.004) and decreased eGFR (p=0.008). An elevated plasma cystatin C was associated with increases in ADMA, SDMA, CRP, homocysteine and age. ADMA, SDMA, CRP and homocysteine levels were not associated with CAD severity. eGFR was negatively associated only with SDMA and homocysteine. In multivariate analysis, increased plasma cystatin C predicted both the occurrence and the severity of CAD more strongly than other measures of renal function.
  
  
  CONCLUSIONS
  We conclude that mild renal impairment detected by elevated cystatin C is associated with both the occurrence and the severity of CAD, independent of the other risk factors we measured and that mild renal impairment results in increased plasma levels of homocysteine, ADMA and SDMA. Our findings suggest a possible mechanistic link between CAD and mild renal impairment in which cystatin C may serve as an early marker for CAD and may also participate directly in atherogenesis.
authors.affiliation: Department of Cardiovascular Medicine, University of New South Wales, Prince of Wales Hospital, Sydney, Australia.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Ah Siew
authors.initials: AS
authors.lastname: Sim
authors.forename: Xing Li
authors.initials: XL
authors.lastname: Wang
authors.forename: Chris
authors.initials: C
authors.lastname: Salonikas
authors.forename: Mary
authors.initials: M
authors.lastname: Moriatis
authors.forename: Daya
authors.initials: D
authors.lastname: Naidoo
authors.forename: David E L
authors.initials: DE
authors.lastname: Wilcken
mesh_terms: D000367:Age Factors; D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000097:blood* / Q000150:complications; D012307:Risk Factors