Renal function and long-term mortality in patients with asymptomatic carotid atherosclerosis

Area of Science:

• Cardiology
• Nephrology
• Biomarkers

Background:

• Renal dysfunction is a known risk factor for mortality in patients with atherosclerosis.
• Estimated glomerular filtration rate (eGFR), cystatin C (CysC), and beta-2-microglobulin (B2M) are common measures of renal function.

Purpose of the Study:

• To determine which renal function parameter (eGFR, CysC, or B2M) is the strongest predictor of mortality in patients with asymptomatic carotid atherosclerosis.
• To evaluate the incremental predictive value of these renal markers in established cardiovascular risk models.

Main Methods:

• Prospective investigation of all-cause and cardiovascular mortality in 1,065 patients with asymptomatic carotid atherosclerosis.
• Analysis included assessment of eGFR, CysC, and B2M as predictors of mortality.
• Statistical models were used to assess independent associations and reclassification improvements (C-statistics, NRI, IDI).

Main Results:

• All investigated renal parameters (eGFR, CysC, B2M) were significantly and independently associated with mortality.
• CysC and B2M significantly improved risk prediction models (C-statistics, NRI, IDI) beyond established cardiovascular risk factors, outperforming eGFR.
• These findings were consistent across subgroups with varying degrees of atherosclerosis.

Conclusions:

• Cystatin C and beta-2-microglobulin are superior independent predictors of mortality in patients with asymptomatic carotid atherosclerosis compared to eGFR.
• These findings suggest CysC and B2M may offer enhanced clinical utility for risk stratification in this patient population.
• Further validation in larger, community-based studies is warranted.