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Published on: September 18, 2017
Cystatin C and sudden cardiac death risk in the elderly
Rajat Deo1, Nona Sotoodehnia, Ronit Katz
1Division of Cardiology, University of Pennsylvania, Philadelphia 19104, USA. Rajat.Deo@uphs.upenn.edu
Insights
Kidney dysfunction, indicated by cystatin C levels, independently increases sudden cardiac death risk in older adults without heart disease. Creatinine-based measures did not show this independent association.
Area of Science:
- Cardiology
- Nephrology
- Epidemiology
Background:
- Emerging evidence links moderate kidney dysfunction to sudden cardiac death (SCD) in individuals with cardiovascular disease.
- Understanding kidney function's role in SCD risk is crucial for preventative strategies.
Purpose of the Study:
- To investigate the independent association between kidney function markers and the risk of sudden cardiac death (SCD) in an elderly population without pre-existing cardiovascular disease.
- To compare the predictive value of cystatin C and creatinine-based estimated glomerular filtration rate (eGFR) for SCD.
Main Methods:
- Longitudinal analysis of 4465 participants from the Cardiovascular Health Study without prevalent cardiovascular disease at baseline.
- Measurement of serum cystatin C and creatinine to assess kidney function.
- Adjudication of sudden cardiac death (SCD) events over an 11.2-year median follow-up, analyzed using multivariate Cox proportional hazards models.
Main Results:
- An increased annual incidence of SCD events was observed across increasing cystatin C tertiles (32 events per 10,000 person-years in the highest tertile).
- Higher cystatin C levels demonstrated a persistent, independent association with increased SCD risk after multivariate adjustment (HR=2.67, 95% CI: 1.33-5.35 in the highest tertile).
- While creatinine-based eGFR showed a trend of increasing SCD incidence across tertiles, no significant independent association with SCD remained after multivariable adjustment.
Conclusions:
- Kidney dysfunction, as assessed by cystatin C, is an independent predictor of sudden cardiac death (SCD) risk in elderly individuals without clinical cardiovascular disease.
- Cystatin C appears to be a more robust marker than creatinine-based eGFR for identifying individuals at higher risk of SCD in this population.
Background:
Recent studies have demonstrated an association between moderate kidney dysfunction and sudden cardiac death in people with cardiovascular disease.
Methods And Results:
The study was a longitudinal analysis among 4465 participants from the Cardiovascular Health Study without prevalent cardiovascular disease at baseline. Cystatin C and creatinine were measured from baseline sera. Sudden cardiac death (SCD) was defined as a sudden pulseless condition from a cardiac origin in a previously stable individual that occurred out of the hospital or in the emergency room. The association between cystatin C tertiles and SCD was determined with multivariate Cox proportional hazards. A similar analysis compared SCD incidence across creatinine-based estimated glomerular filtration rate (eGFR) tertiles. Over a median follow-up of 11.2 years, 91 adjudicated SCD events occurred. The annual incidence of SCD events increased across cystatin C tertiles: 10 events per 10 000 person years in tertile 1, 25 events per 10 000 person years in tertile 2, and 32 events per 10 000 person-years in the highest cystatin C tertile. These associations persisted after multivariate adjustment: hazards ratio=2.72; 95% confidence interval, 1.44 to 5.16 in tertile 2 and hazards ratio=2.67; 95% confidence interval, 1.33 to 5.35 in tertile 3. After multivariate adjustment, the rate of SCD also increased in a linear distribution across creatinine-based eGFR tertiles: 15 events per 10 000 person-years in tertile 1, 22 events per 10 000 person-years in tertile 2, and 27 events per 10 000 person-years in tertile 3. No significant associations, however, remained between creatinine-based eGFR and SCD after multivariable adjustment.
Conclusions:
Impaired kidney function, as measured by cystatin C, has an independent association with SCD risk among elderly persons without clinical cardiovascular disease.
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