Cystatin C as risk factor for cardiovascular events and all-cause mortality in the general population. The Tromsø
Ingrid Toft1, Marit Solbu, Jens Kronborg
1Department of Nephrology, University Hospital of North Norway, and Department of Clinical Medicine, University of Tromsø, Tromsø, Norway. Ingrid.Toft@unn.no
Insights
Cystatin C is not linked to heart attack or stroke in the general population. However, elevated cystatin C levels indicate a higher risk of death in women.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Reduced glomerular filtration rate (<60 mL/min/1.73 m2) is a known cardiovascular risk factor.
- Cystatin C may be a more sensitive marker than creatinine for detecting mild kidney dysfunction and assessing cardiovascular risk and mortality.
- This study investigates the association between cystatin C levels and cardiovascular morbidity and all-cause mortality.
Purpose of the Study:
- To examine the association of cystatin C with cardiovascular morbidity and all-cause mortality.
- To determine if cystatin C is a better predictor of cardiovascular risk and mortality than creatinine.
- To assess gender-specific associations of cystatin C with adverse health outcomes.
Main Methods:
- Cystatin C levels were measured in 5975 participants (2852 men, 3153 women) in the Tromsø Study (1994/95).
- Gender-specific Cox proportional hazard ratios (HRs) were calculated for all-cause mortality (12-year follow-up) and myocardial infarction (MI) and ischaemic stroke (9.5-year follow-up).
Main Results:
- During follow-up, 591 MIs, 293 ischaemic strokes, and 1262 deaths occurred.
- In women, the upper quartile of cystatin C (≥0.93 mg/L) was associated with a 38% increased risk of all-cause mortality (HR 1.38; 95% CI 1.04-1.84).
- A significant gender interaction was observed; a one SD increase in cystatin C was associated with a 9% higher risk of death in women, even after excluding individuals with a cancer history. Crude associations with MI and stroke were observed in both genders but did not persist after adjustments. No independent associations were found in non-gender-specific analyses.
Conclusions:
- Cystatin C was not independently associated with fatal or non-fatal myocardial infarction or ischaemic stroke in the general population.
- Cystatin C emerged as a significant risk factor for all-cause mortality specifically in women.
- These findings highlight the gender-specific role of cystatin C in predicting mortality risk.
Background:
Glomerular filtration rate<60 mL/min/1.73 m2 is associated with increased cardiovascular risk. Cystatin C is believed to be a better tool than creatinine for detection of mild renal dysfunction (>60 mL/min/1.73 m2) and possibly a more sensitive marker for cardiovascular risk and all-cause mortality. We examined the association of cystatin C with cardiovascular morbidity and all-cause mortality in a prospective population-based study.
Methods:
Cystatin C was measured in 2852 men and 3153 women in the Tromsø Study 1994/95. Gender-specific associations during 12 years of follow-up for all-cause mortality and 9.5 years for myocardial infarction (MI) and ischaemic stroke were assessed (Cox proportional hazard ratios, HRs).
Results:
During follow-up, 591 MIs, 293 ischaemic strokes and 1262 deaths occurred. In women, HR for all-cause mortality was increased in the upper cystatin C quartile (≥0.93 mg/L) compared with the lowest quartile (≤0.73 mg/L); 1.38, 95% confidence interval 1.04-1.84. A significant interaction with gender was observed. One SD (0.17 mg/L) increase in cystatin C was associated with 9% higher risk of death in women, also when persons with a cancer history were excluded. Crude HRs for MI and ischaemic stroke were increased in both genders, but the associations did not persist after multivariable adjustments. No independent associations with end points were observed in non-gender-specific analyses.
Conclusions:
Cystatin C was not independently associated with fatal and non-fatal MI or ischaemic stroke in the general population. However, cystatin C was a risk factor for all-cause mortality in women.
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