Association of cystatin C with ischemia in patients with coronary heart disease.
BACKGROUND
Elevated concentrations of cystatin C are associated with greater cardiovascular morbidity and mortality. We sought to determine whether elevated concentrations of cystatin C were associated with inducible ischemia in patients with coronary heart disease (CHD).


METHODS
We measured serum cystatin C and performed exercise treadmill testing with stress echocardiography in a cross-sectional study of 899 outpatients with CHD.


RESULTS
Among the 241 participants in the highest quartile of cystatin C (>1.30 mg/L), 38% had inducible ischemia, compared with 13% of those in the lowest quartile of cystatin C < 0.92 mg/L; adjusted odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.2 to 3.8; p = 0.01). However, this association differed in participants with and without a history of coronary artery bypass graft (CABG), as well as in users and nonusers of beta-blockers and statins (p values for interaction < 0.1). Among participants without a history of CABG, 35% of those in the highest quartile and 9% of those in the lowest quartile of cystatin C had inducible ischemia (adjusted OR: 3.05; 95% CI: 1.3-6.9; p = 0.008). Among participants who were not using beta-blockers, 44% of those in the highest quartile and 7% in the lowest quartile of cystatin C had inducible ischemia (adjusted OR: 5.3; 95% CI: 1.8-15.5; p = 0.002). Among participants who were not using statins, 39% of participants in the highest quartile and 4% of those in the lowest quartile had inducible ischemia (adjusted OR: 10.3; 95% CI: 2.5-43.3; p = 0.001).


CONCLUSIONS
Elevated levels of cystatin C are independently associated with inducible ischemia among outpatients with stable coronary disease.
Deo
Rajet
R
Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rajet.Deo@uphs.upenn.edu
Shlipak
Michael G
MG
Ix
Joachim H
JH
Ali
Sadia
S
Schiller
Nelson B
NB
Whooley
Mary A
MA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood*; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015854:Up-Regulation
D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors