Reduced kidney function estimated by cystatin C and clinical outcomes in hypertensive patients with coronary artery disease: association with homocysteine and other cardiovascular risk factors.
OBJECTIVE
To evaluate the association between serum cystatin C and homocysteine concentrations, cardiovascular risk factors and cardiovascular events in hypertensive patients with coronary artery disease (CAD).


METHODS
260 patients with hypertension and CAD (mean age 56.9 +/- 9.3) were included. During a mean 40-month follow-up the combined end-point of death from all causes, non-fatal myocardial infarction and stroke or coronary revascularization was assessed.


RESULTS
Subjects in the highest serum cystatin C quartile (>103.4 nmol/l) as compared with the lowest were older, were characterized by a higher frequency of multivessel CAD, higher levels of homocysteine (13.2 +/- 5.2 vs. 11.4 +/- 4.2 micromol/l; p < 0.01), fibrinogen and high-sensitivity C-reactive protein and by an increased intima-media thickness. Combined end-point occurred twice as frequently in the 4th quartile of serum cystatin C as compared with the 1st quartile (10.8 vs. 20.3%; p = 0.11). In an univariate analysis, but not in a multivariate model, cystatin C concentration predicted the combined end-point (Exp(B) = 1.096; p < 0.05).


CONCLUSIONS
In hypertensive patients with CAD, serum cystatin C level was independently associated with the extent of CAD, homocysteine plasma level and traditional vascular risk factors. However, serum cystatin C concentration did not independently predict the combined end-point.
1st Department of Coronary Artery Disease, Institute of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Zofia
Z
Dzielinska
Andrzej
A
Januszewicz
Andrzej
A
Wiecek
Aleksander
A
Prejbisz
Tomasz
T
Zielinski
Jerzy
J
Chudek
Magdalena
M
Makowiecka-Ciesla
Marcin
M
Demkow
Pawel
P
Tyczynski
Magdalena
M
Januszewicz
Witold
W
Ruzyllo
Marek
M
Naruszewicz
D000368:Aged; D002318:Cardiovascular Diseases; D003324:Coronary Artery Disease / Q000150:complications*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
D055316:Cystatin C; D006710:Homocysteine