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Cystatin C concentration as a predictor of systolic and diastolic heart failure
Andrew Moran1, Ronit Katz, Nicolas L Smith
1Department of Medicine, University of California at San Francisco, San Francisco, California, USA.
Insights
Kidney dysfunction, indicated by cystatin C, is linked to heart failure (HF). Higher cystatin C levels linearly predict systolic HF, but only the highest levels predict diastolic HF.
Area of Science:
- Cardiology
- Nephrology
- Epidemiology
Background:
- Heart failure (HF) risk factors may vary by ejection fraction (EF).
- Elevated cystatin C, a kidney dysfunction marker, is linked to incident HF.
- Previous studies lacked EF data at HF diagnosis.
Purpose of the Study:
- To investigate if kidney dysfunction predicts diastolic HF (DHF) better than systolic HF (SHF).
- To examine the association between cystatin C and incident DHF versus SHF in the Cardiovascular Health Study.
Main Methods:
- Cystatin C levels were measured in 4453 participants without HF at baseline.
- Incident HF was classified as DHF (EF ≥ 50%) or SHF (EF < 50%).
- Associations between cystatin C and DHF/SHF risk were analyzed after adjusting for covariates.
Main Results:
- Over 8 years, 167 participants developed DHF and 206 developed SHF.
- Higher cystatin C quartiles showed a linear association with SHF risk (P < .001).
- Increased DHF risk was only observed at the highest cystatin C quartile.
Conclusions:
- Cystatin C levels are linearly associated with systolic HF incidence.
- Only the highest cystatin C concentrations are predictive of diastolic HF.
Background:
Risk factors for heart failure (HF) may differ according to ejection fraction (EF). Higher cystatin C, a marker of kidney dysfunction, is associated with incident HF, but previous studies did not determine EF at diagnosis. We hypothesized that kidney dysfunction would predict diastolic HF (DHF) better than systolic HF (SHF) in the Cardiovascular Health Study.
Methods And Results:
Cystatin C was measured in 4453 participants without HF at baseline. Incident HF was categorized as DHF (EF > or = 50%) or SHF (EF < 50%). We compared the association of cystatin C with the risk for DHF and SHF, after adjustment for age, sex, race, medications, and HF risk factors. During 8 years of follow-up, 167 participants developed DHF and 206 participants developed SHF. After adjustment, sequentially higher quartiles of cystatin C were associated with risk for SHF (competing risks hazard ratios 1.0 [reference], 1.99 [95% confidence interval 1.14-3.48], 2.32 [1.32-4.07], 3.17 [1.82-5.50], P for trend < .001). The risk for DHF was apparent only at the highest cystatin C quartile (hazard ratios 1.0 [reference], 1.09 [0.62-1.89], 1.08 [0.61-1.93], and 1.83 [1.07-3.11]).
Conclusions:
Cystatin C levels are linearly associated with the incidence of systolic HF, whereas only the highest concentrations of cystatin C predict diastolic HF.
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