title: Association of albumin-creatinine ratio and cystatin C with change in ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  Low ankle-brachial index (ABI) is a reflection of atherosclerotic disease, and high ABI is an indicator of calcified vessels. The associations of albuminuria and cystatin C level with incidence of either low or high ABI are unknown.
  
  
  METHODS
  Prospective longitudinal cohort study.
  
  
  METHODS
  MESA (Multi-Ethnic Study of Atherosclerosis) enrolled community-dwelling adults (N=6,814) aged 45-84 years who were free of clinical cardiovascular disease at baseline.
  
  
  METHODS
  Baseline albumin-creatinine ratio (ACR) and serum cystatin C level.
  
  
  RESULTS
  Development of low (<0.90), and high (>1.40) ABI using multinomial regression among persons with ABI of 0.90-1.40 at baseline.
  
  
  RESULTS
  During 9.8 years of follow-up, 221 and 89 participants progressed to low and high ABIs, respectively. Baseline ACR and cystatin C level were higher among progressors compared with nonprogressors. In multivariable analyses, doubling of ACR was associated with increased risk of progression to low (OR, 1.08; 95% CI, 0.99-1.20) and high (OR, 1.16; 95% CI, 1.01-1.32) ABIs. Compared to the lowest quintile, the highest quintile of ACR had a significantly increased risk of progression to low (OR, 1.79; 95% CI, 1.03-3.12) and high (OR, 2.76; 95% CI, 1.32-5.77) ABIs. Higher cystatin C levels were associated with progression to low (OR per 1-SD greater, 1.12; 95% CI, 1.00-1.26) but not high (OR per 1-SD greater, 1.01; 95% CI, 0.81-1.25) ABI, but the highest quintile of cystatin C was not associated independently with either outcome.
  
  
  CONCLUSIONS
  Single measure of albuminuria and low number of progressors to high ABI.
  
  
  CONCLUSIONS
  In adults free of clinical cardiovascular disease, albuminuria was a strong independent risk factor for the development of both high and low ABIs, important and different measures of peripheral artery disease.
authors.affiliation: Tufts Medical Center, Boston, MA.
authors.forename: Pranav S
authors.initials: PS
authors.lastname: Garimella
authors.affiliation: University of California, San Diego, CA.
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ix
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: University of California, San Diego, CA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.affiliation: Loyola University, Chicago, IL.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.affiliation: Oregon Health & Science University, Portland, OR.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Sibley
authors.affiliation: Tufts Medical Center, Boston, MA. Electronic address: msarnak@tuftsmedicalcenter.org.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis*; D055109:Ankle Brachial Index; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control; D003404:Creatinine / Q000652:urine*; D055316:Cystatin C / Q000097:blood*; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D012307:Risk Factors; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology
chemical_list: D055316:Cystatin C; D003404:Creatinine
keywords: Cystatin C; albumin-creatinine ratio (ACR); albuminuria; ankle-brachial index (ABI); atherosclerotic disease; cardiovascular disease (CVD); chronic kidney disease (CKD); peripheral artery disease (PAD)