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Atherosclerosis. 2014 May;234(1):108-13. doi: 10.1016/j.atherosclerosis.2014.02.020. Epub 2014 Feb 28.

Increased urinary cystatin C indicated higher risk of cardiovascular death in a community cohort.

Author information

1
Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: Johanna.Helmersson_Karlqvist@medsci.uu.se.
2
Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Science for Life Laboratory, Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden.
3
Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Centre for Family and Community Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
4
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.

Abstract

OBJECTIVES:

Urinary cystatin C (u-CysC) is a new biomarker for acute tubular kidney dysfunction and may also indicate chronic tubular dysfunction. Chronic kidney disease is an important cardiovascular risk factor, however it is not known if u-CysC is a risk marker for cardiovascular death.

METHODS:

The association between u-CysC and cardiovascular mortality was investigated in a Swedish community-based cohort of 604 men aged 78 years. During follow-up (mean 6.7 years), 203 participants died, of which 90 due to cardiovascular causes.

RESULTS:

High u-CysC (>0.029 mg/mmol Cr) was associated with a more than 2-fold risk of cardiovascular death (multivariable hazard ratio for quintile 5 vs. 1: 2.5, 95% CI 1.2-5.2, P < 0.05) in Cox regression models independent of cardiovascular risk factors, glomerular filtration rate (eGFR) and urinary Albumin. Participants with low eGFR (≤60 mL/min), albuminuria (≥3 mg/mmol Cr) and high u-CysC (>0.029 mg/mmol Cr) combined had a significantly higher cardiovascular mortality risk compared to participants with one or two of these biomarkers normal (hazard ratio 15, 95% CI: 6.7-36, P < 0.001, compared to all three biomarkers normal).

CONCLUSIONS:

This study is the first to show that increased concentrations of the tubular kidney biomarker u-CysC indicated risk of cardiovascular death independently of other cardiovascular risk factors, glomerular filtration and albuminuria. Additional research is needed to further establish the usefulness of u-CysC in clinical practice.

KEYWORDS:

Atherosclerosis; Chronic kidney disease; Epidemiology; Mortality; Risk factors

[Indexed for MEDLINE]

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