Cystatin C is independently associated with total and cardiovascular mortality in individuals undergoing coronary angiography. The Ludwigshafen Risk and Cardiovascular Health (LURIC) study

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• 作者：Rainer P. Woitas ; Marcus E. Kleber ; Andreas Meinitzer ; Tanja B. Grammer ; G¨¹nther Silbernagel ; Stefan Pilz ; Andreas Tomaschitz ; Gisela Weihrauch ; Harald Dobnig ; Winfried M?rz ; Hubert Scharnagl
• 关键词：Cystatin C ; Renal function ; eGFR ; Mortality ; Coronary artery disease
• 刊名：Atherosclerosis
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：229
• 期：2
• 页码：541-548
• 全文大小：367 K

文摘

Aims

Cystatin C is a well established marker of kidney function. There is evidence that cystatin C concentrations are also associated with mortality. The present analysis prospectively evaluated the associations of cystatin C with all-cause and cardiovascular (CV) mortality in a well-characterized cohort of persons undergoing angiography, but without overt renal insufficiency.

Methods

Cystatin C was available in 2998 persons (mean age: 62.7?¡À?10.5 years; 30.3 % women). Of those 2346 suffered from coronary artery disease (CAD) and 652 (controls) did not. Creatinine (mean?¡À?SD: 83.1?¡À?47.8 vs. 74.1?¡À?24.7?¦Ìmol/L, p?=?0.036) but not Cystatin C (mean?¡À?SD: 1.02?¡À?0.44 vs. 0.92?¡À?0.26?mg/L, p?=?0.065) was significantly higher in patients with CAD. After a median follow-up of 9.9 years, in total 898 (30 % ) deaths occurred, 554 (18.5 % ) due to CV disease and 326 (10.9 % ) due to non-CV causes. Multivariable-adjusted Cox analysis (adjusting for eGFR and established cardiovascular risk factors, lipid lowering therapy, angiographic coronary artery disease, and C-reactive protein) revealed that patients in the highest cystatin C quartile were at an increased risk for all-cause (hazard ratio (HR) 1.93, 95 % CI 1.50-2.48) and CV mortality (HR 2.05 95 % CI 1.48-2.84) compared to those in the lowest quartile. The addition of cystatin C to a model consisting of established cardiovascular risk factors increased the area under the receiver-operating characteristic curve for CV and all-cause mortality, but the difference was statistically not significant. However, reclassification analysis revealed significant improvement by addition of cystatin C for CV and all-cause mortality (p?<?0.001), respectively.

Conclusion

The concentration of cystatin C is strongly associated with long-term all-cause and cardiovascular mortality in patients referred to coronary angiography, irrespective of creatinine-based renal function.