Preventive cardiology| Volume 102, ISSUE 1, P54-57, July 01, 2008

Serum Cystatin C and Increased Coronary Heart Disease Prevalence in US Adults Without Chronic Kidney Disease

      Previous studies indicated that serum cystatin C, a marker of renal function, was associated with cardiovascular disease (CVD). However, few data about this association are available for persons without chronic kidney disease or albuminuria. Data from 4,991 subjects in the Third National Health and Nutrition Examination Survey with an estimated glomerular filtration rate ≥60 ml/min/1.73 m2 without micro- or macroalbuminuria were analyzed. Subjects were categorized into quartiles of serum cystatin C and compared for prevalence of CVD. CVD was defined as a history of myocardial infarction, angina, or stroke. After age standardization, prevalences of CVD from the lowest to highest quartile of serum cystatin C were 6.0%, 8.8%, 11.8%, and 16.7% (p-trend = 0.006). Also, age-standardized prevalences of myocardial infarction across quartiles of serum cystatin C were 1.9%, 4.4%, 6.6%, and 8.6%; age-standardized prevalences of angina were 2.4%, 4.4%, 4.2%, and 7.1%; and age-standardized prevalences of stroke were 2.5%, 1.6%, 3.5%, and 4.4% (each p-trend <0.05). Each 1-SD higher serum cystatin C level was associated with a multivariate prevalence ratio of CVD of 1.55 (95% confidence interval [CI] 1.13 to 2.13), and multivariate-adjusted prevalence ratios were 1.44 (95% CI 1.01 to 2.07), 1.64 (95% CI 1.02 to 2.64), and 1.65 (95% CI 1.06 to 2.56) for myocardial infarction, angina, and stroke, respectively. In conclusion, a graded association exists between higher serum cystatin C and increased CVD prevalence in patients without established chronic kidney disease.
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        • Shlipak M.G.
        • Katz R.
        • Sarnak M.J.
        • Fried L.F.
        • Newman A.B.
        • Stehman-Breen C.
        • Seliger S.L.
        • Kestenbaum B.
        • Psaty B.
        • Tracy R.P.
        • Siscovick D.S.
        Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease.
        Ann Intern Med. 2006; 145: 237-246
        • Ix J.H.
        • Shlipak M.G.
        • Chertow G.M.
        • Whooley M.A.
        Association of cystatin C with mortality, cardiovascular events, and incident heart failure among persons with coronary heart disease: data from the Heart and Soul Study.
        Circulation. 2007; 115: 173-179
        • National Center for Health Statistics
        Plan and operation of the Third National Health and Nutrition Examination Survey, 1988–1994, Hyattsville, Maryland.
        US Dept of Health and Human Services publication 94–1308, 1994 (1)
        • National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification
        Kidney Disease Outcome Quality Initiative.
        Am J Kidney Dis. 2002; 39: S1-S246
        • National Center for Health Statistics
        National Health and Nutrition Examination Survey Laboratory Procedures Manual.
        (Accessed November 14, 2007)
        • Levey A.S.
        • Bosch J.P.
        • Lewis J.B.
        • Greene T.
        • Rogers N.
        • Roth D.
        A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation.
        Ann Intern Med. 1999; 130: 461-470
        • Laterza O.F.
        • Price C.P.
        • Scott M.G.
        Cystatin C: an improved estimator of glomerular filtration rate?.
        Clin Chem. 2002; 48: 699-707
        • Dharnidharka V.R.
        • Kwon C.
        • Stevens G.
        Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis.
        Am J Kidney Dis. 2002; 40: 221-226
        • Rule A.D.
        • Larson T.S.
        • Bergstralh E.J.
        • Slezak J.M.
        • Jacobsen S.J.
        • Cosio F.G.
        Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease.
        Ann Intern Med. 2004; 141: 929-937
        • Levey A.S.
        • Coresh J.
        • Greene T.
        • Stevens L.A.
        • Zhang Y.L.
        • Hendriksen S.
        • Kusek J.W.
        • Van L.F.
        Using standardized serum creatinine values in the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate.
        Ann Intern Med. 2006; 145: 247-254
        • Stevens L.A.
        • Manzi J.
        • Levey A.S.
        • Chen J.
        • Deysher A.E.
        • Greene T.
        • Poggio E.D.
        • Schmid C.H.
        • Steffes M.W.
        • Zhang Y.L.
        • Van L.F.
        • Coresh J.
        Impact of creatinine calibration on performance of GFR estimating equations in a pooled individual patient database.
        Am J Kidney Dis. 2007; 50: 21-35
        • Muntner P.
        • He J.
        • Hamm L.
        • Loria C.
        • Whelton P.K.
        Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States.
        J Am Soc Nephrol. 2002; 13: 745-753
        • Beddhu S.
        • Len-Brady K.
        • Cheung A.K.
        • Horne B.D.
        • Bair T.
        • Muhlestein J.B.
        • Anderson J.L.
        Impact of renal failure on the risk of myocardial infarction and death.
        Kidney Int. 2002; 62: 1776-1783
        • Menon V.
        • Shlipak M.G.
        • Wang X.
        • Coresh J.
        • Greene T.
        • Stevens L.
        • Kusek J.W.
        • Beck G.J.
        • Collins A.J.
        • Levey A.S.
        • Sarnak M.J.
        Cystatin C as a risk factor for outcomes in chronic kidney disease.
        Ann Intern Med. 2007; 147: 19-27
        • Shlipak M.G.
        • Wassel Fyr C.L.
        • Chertow G.M.
        • Harris T.B.
        • Kritchevsky S.B.
        • Tylavsky F.A.
        • Satterfield S.
        • Cummings S.R.
        • Newman A.B.
        • Fried L.F.
        Cystatin C and mortality risk in the elderly: the Health, Aging, and Body Composition Study.
        J Am Soc Nephrol. 2006; 17: 254-261