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

Woitas, Rainer P; Kleber, Marcus E; Meinitzer, Andreas; Grammer, Tanja B; Silbernagel, Günther; Pilz, Stefan; Tomaschitz, Andreas; Weihrauch, Gisela; Dobnig, Harald; März, Winfried; Scharnagl, Hubert (2013). Cystatin C is independently associated with total and cardiovascular mortality in individuals undergoing coronary angiography. The Ludwigshafen Risk and Cardiovascular Health (LURIC) study. Atherosclerosis, 229(2), pp. 541-548. Elsevier 10.1016/j.atherosclerosis.2013.04.027

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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 ± 10.5 years; 30.3% women). Of those 2346 suffered from coronary artery disease (CAD) and 652 (controls) did not. Creatinine (mean ± SD: 83.1 ± 47.8 vs. 74.1 ± 24.7 μmol/L, p = 0.036) but not Cystatin C (mean ± SD: 1.02 ± 0.44 vs. 0.92 ± 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.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
UniBE Contributor:	Silbernagel, Günther
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0021-9150
Publisher:	Elsevier
Language:	English
Submitter:	Catherine Gut
Date Deposited:	08 Jul 2014 09:54
Last Modified:	05 Dec 2022 14:33
Publisher DOI:	10.1016/j.atherosclerosis.2013.04.027
PubMed ID:	23706287
Uncontrolled Keywords:	Coronary artery disease, Cystatin C, Mortality, Renal function eGFR
URI:	https://boris.unibe.ch/id/eprint/50726