Cystatin C concentration as a predictor of systolic and diastolic heart failure.
BACKGROUND
Risk factors for heart failure (HF) may differ according to ejection fraction (EF). Higher cystatin C, a marker of kidney dysfunction, is associated with incident HF, but previous studies did not determine EF at diagnosis. We hypothesized that kidney dysfunction would predict diastolic HF (DHF) better than systolic HF (SHF) in the Cardiovascular Health Study.


RESULTS
Cystatin C was measured in 4453 participants without HF at baseline. Incident HF was categorized as DHF (EF > or = 50%) or SHF (EF < 50%). We compared the association of cystatin C with the risk for DHF and SHF, after adjustment for age, sex, race, medications, and HF risk factors. During 8 years of follow-up, 167 participants developed DHF and 206 participants developed SHF. After adjustment, sequentially higher quartiles of cystatin C were associated with risk for SHF (competing risks hazard ratios 1.0 [reference], 1.99 [95% confidence interval 1.14-3.48], 2.32 [1.32-4.07], 3.17 [1.82-5.50], P for trend < .001). The risk for DHF was apparent only at the highest cystatin C quartile (hazard ratios 1.0 [reference], 1.09 [0.62-1.89], 1.08 [0.61-1.93], and 1.83 [1.07-3.11]).


CONCLUSIONS
Cystatin C levels are linearly associated with the incidence of systolic HF, whereas only the highest concentrations of cystatin C predict diastolic HF.
Moran
Andrew
A
Department of Medicine, University of California at San Francisco, San Francisco, California, USA.
Katz
Ronit
R
Smith
Nicolas L
NL
Fried
Linda F
LF
Sarnak
Mark J
MJ
Seliger
Stephen L
SL
Psaty
Bruce
B
Siscovick
David S
DS
Gottdiener
John S
JS
Shlipak
Michael G
MG
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D016001:Confidence Intervals; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D004452:Echocardiography / Q000379:methods; D005260:Female; D054144:Heart Failure, Diastolic / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality; D054143:Heart Failure, Systolic / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis
D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins