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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
The relationship of cystatin C, creatinine, estimated GFR, and cardiovascular events
1Department of Cardiology, Central Hospital of Xiangfan, Xiangfan 441021, China. tychozhang@126.com
Insights
Plasma cystatin C and estimated glomerular filtration rate (eGFR) predict cardiovascular disease risk in Chinese adults. While eGFR is a better predictor for coronary heart disease, cystatin C shows stronger association with ischemic stroke risk.
Area of Science:
- Nephrology
- Cardiology
- Biomarkers
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality globally.
- Renal function markers, including plasma cystatin C, creatinine, and estimated glomerular filtration rate (eGFR), are increasingly recognized for their association with CVD risk.
- Understanding the differential predictive value of these markers in diverse populations is crucial for risk stratification.
Purpose of the Study:
- To evaluate the predictive capability of plasma cystatin C, creatinine, and eGFR for cardiovascular disease (CVD) in a Chinese population.
- To compare the association of these renal function markers with coronary heart disease (CHD) and ischemic stroke.
- To determine the independent risk factor status of plasma cystatin C for CVD.
Main Methods:
- A case-control study involving 466 CHD patients and 349 healthy controls from Wuhan, China.
- Plasma levels of cystatin C and creatinine were measured.
- Glomerular filtration rate (GFR) was estimated using the Cockcroft-Gault formula, adjusted for body surface area.
- Participants were stratified into quintiles based on each marker for risk analysis.
Main Results:
- Patients exhibited significantly higher plasma cystatin C and creatinine levels, and lower eGFR compared to controls.
- Lower eGFR demonstrated a dose-dependent association with increased risk of cardiovascular events.
- Plasma cystatin C and creatinine showed similar hazard ratios for CHD, while cystatin C demonstrated a stronger association with ischemic stroke risk.
- Plasma cystatin C was identified as a more potent predictor for ischemic stroke than eGFR or creatinine.
Conclusions:
- Plasma cystatin C, despite its association with renal function, is not an independent risk factor for overall cardiovascular disease.
- Estimated glomerular filtration rate (eGFR) serves as a superior risk predictor for coronary heart disease (CHD) compared to plasma cystatin C and creatinine.
- Plasma cystatin C emerges as a more significant risk factor for ischemic stroke than creatinine and eGFR in this Chinese cohort.
Abstract:
This study examined the predictive value of plasma cystatin C, creatinine and estimated glomerular filtration rate (eGFR) as risk factors for cardiovascular disease in Chinese. Plasma cystatin C and creatinine were measured in 466 coronary heart disease (CHD) patients recruited from 4 hospitals and 349 healthy controls from local communities in Wuhan, China. Cockroft-Gault formula was used to estimate the glomerular filtration rate (GFR) after adjusting for body surface area. With each measure, the study population was divided into quintiles. The results showed that the patients had significantly higher levels of plasma cystatin C, creatinine, and lower level of eGFR than controls. Lower eGFR was associated with a higher risk of cardiovascular events. As compared with the first (highest) quintile, the hazard ratios (and 95% CIs) after multivariate adjustment for CHD were as follows: third quintile, 2.98 (1.54-5.78); fourth quintile, 3.34 (1.58-7.09); fifth quintile, 4.37(1.84-10.35). With higher cystatin C quintiles (≥1.00 mg/L and ≥1.17 mg/L), the hazard ratios for CHD were 2.16 (1.23-3.81) and 2.34 (1.25-4.38), similar to those of creatinine 2.21 (1.21-4.03) and 2.03 (1.07-3.84). However, it was plasma cystatin C not eGFR or creatinine had stronger association with ischemic stroke. The highest quintile had the hazard ratio of 4.51 (1.45-14.08) after multivariate adjustment. It was concluded that plasma cystatin C, associated with renal function, is not an independent risk factor for cardiovascular disease. eGFR is a better risk predictor for CHD than plasma cystatin C and creatinine. But for ischemic stroke, plasma cystatin C is a better risk factor than creatinine and estimated GFR.
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