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Clinical correlates and heritability of cystatin C (from the Framingham Offspring Study)
Nisha I Parikh1, Shih-Jen Hwang, Qiong Yang
1National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA.
Insights
High levels of Cystatin C (CysC) correlate with cardiovascular disease (CVD) risk factors, even without chronic kidney disease (CKD). These associations may explain CysC
Area of Science:
- Clinical Biochemistry
- Cardiovascular Medicine
- Nephrology
Background:
- Cystatin C (CysC) is recognized as a biomarker linked to cardiovascular disease (CVD) and chronic kidney disease (CKD).
- Understanding the clinical correlates and genetic basis of CysC is crucial for its interpretation in disease risk assessment.
Purpose of the Study:
- To investigate the clinical factors associated with elevated Cystatin C (CysC) levels.
- To determine the heritability of CysC.
- To examine whether the relationship between CVD risk factors and CysC is modified by the presence of CKD.
Main Methods:
- Analysis of data from the Framingham Heart Study offspring cohort (n=3,241).
- Development of a 95th percentile cut-point for high CysC in a healthy subset, excluding participants with prevalent CVD, CKD, and other risk factors.
- Multivariable logistic regression to assess associations between CVD risk factors and high CysC; variance-components method for heritability estimation in a family-based subset (n=1,188).
Main Results:
- A cut-point for high CysC was established at 1.07 mg/L.
- Age, hypertension treatment, low diastolic blood pressure, body mass index, low high-density lipoprotein cholesterol, and smoking were significantly associated with high CysC.
- These factors, along with estimated glomerular filtration rate (eGFR), explained 39.2% of CysC variability. Heritability of CysC was estimated at 0.35 (p <0.001). Associations remained consistent when CKD was excluded.
Conclusions:
- Elevated Cystatin C (CysC) is associated with multiple cardiovascular disease (CVD) risk factors, independent of chronic kidney disease (CKD) status.
- The strong link between CysC and CVD risk factors provides a potential explanation for CysC's predictive power in incident CVD.
Abstract:
Cystatin C (CysC) is associated with cardiovascular disease (CVD) and chronic kidney disease (CKD). We examined the clinical correlates and heritability of CysC and determined if associations between CVD risk factors and CysC differed by CKD status. Among Framingham Heart Study offspring (examined from 1998-2001, n = 3,241, mean age 61 years, 54% women), the 95(th) percentile cut-point was developed for CysC in a healthy subset (n = 779) after excluding participants with diabetes, hypertension, low high-density lipoproteins, obesity, smoking, high triglycerides, prevalent CVD, and CKD (as defined by glomerular filtration rate <60 mL/min per 1.73 m(2)). Multivariable logistic regression was used to evaluate the association between CVD risk factors and high CysC (CysC > or =95(th) percentile cut-point). In a family-based subset (n = 1,188), we estimated CysC heritability using the variance-components method. The cut-point for high CysC was 1.07 mg/L. Age, hypertension treatment, low diastolic blood pressure, body mass index, low high-density lipoprotein cholesterol, and smoking were associated with high CysC in multivariable models. These factors and estimated glomerular filtration rate (egFR) explained 39.2% of CysC variability (R(2)). Excluding CKD did not materially change associations. Multivariable-adjusted heritability for CysC was 0.35 (p <0.001). In conclusion, high CysC is associated with CVD risk factors even in the absence of CKD. The strong associations between CysC and CVD risk factors may partially explain why CysC is a strong predictor of incident CVD.
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