Cystatin C and the risk for cardiovascular events in patients with asymptomatic carotid atherosclerosis.
OBJECTIVE
Renal dysfunction is a risk factor for cardiovascular events in patients with atherosclerosis. Unlike serum creatinine or estimated glomerular filtration rate, cystatin C reflects renal dysfunction independent of factors such as sex, weight, and race. We investigated whether baseline serum levels of cystatin C predict major cardiovascular events in patients with asymptomatic carotid atherosclerosis and compared the predictive value of cystatin C to these established markers of renal function.


METHODS
We prospectively studied 1004 of 1286 consecutive patients with carotid ultrasound scanning. Patients were followed for the occurrence of major cardiovascular events, a composite of myocardial infarction, percutaneous coronary intervention, coronary bypass graft, stroke, and death.


RESULTS
During a median of 3 years of follow-up, we recorded 346 major cardiovascular events in 311 patients. The risk for a first major cardiovascular event increased significantly with increasing quintiles of cystatin C; hazard ratios ranged from 1.18 to 1.94 for the highest versus the lowest quintile (P<0.001 for trend). Creatinine levels showed no significant association with major cardiovascular events, and for glomerular filtration rate, only the lowest quintile was moderately associated with adverse cardiovascular outcome.


CONCLUSIONS
Cystatin C was significantly and gradually associated with future cardiovascular events in patients with carotid atherosclerosis. In contrast, neither serum creatinine nor estimated glomerular filtration rate were significant predictors of adverse cardiovascular outcomes.
Department of Angiology, Medical University, Vienna General Hospital, Vienna, Austria. matthias.hoke@meduniwien.ac.at
Matthias
M
Hoke
Jasmin
J
Amighi
Wolfgang
W
Mlekusch
Oliver
O
Schlager
Markus
M
Exner
Schila
S
Sabeti
Petra
P
Dick
Renate
R
Koppensteiner
Erich
E
Minar
Helmut
H
Rumpold
Oswald
O
Wagner
Martin
M
Schillinger
D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D002340:Carotid Artery Diseases / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D014463:Ultrasonography
D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine