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Increased urinary cystatin C indicated higher risk of cardiovascular death in a community cohort
Johanna Helmersson-Karlqvist1, Johan Ärnlöv2, Axel C Carlsson3
1Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Insights
Urinary cystatin C (u-CysC), a marker for kidney tubular dysfunction, independently predicts cardiovascular death risk. High u-CysC levels significantly increase the likelihood of fatal cardiovascular events, highlighting its potential as a key clinical biomarker.
Area of Science:
- Nephrology
- Cardiology
- Biomarker Research
Background:
- Chronic kidney disease (CKD) is a significant cardiovascular risk factor.
- Urinary cystatin C (u-CysC) is an emerging biomarker for acute and chronic kidney tubular dysfunction.
- The association between u-CysC and cardiovascular mortality remains largely unexplored.
Purpose of the Study:
- To investigate the association between urinary cystatin C (u-CysC) and cardiovascular mortality.
- To determine if u-CysC serves as an independent risk marker for cardiovascular death.
Main Methods:
- A community-based cohort study of 604 elderly men (mean age 78 years) was conducted.
- Urinary cystatin C (u-CysC) levels were measured and associated with cardiovascular mortality over a mean follow-up of 6.7 years.
- Cox regression models were used, adjusting for cardiovascular risk factors, eGFR, and albuminuria.
Main Results:
- High u-CysC levels were associated with a >2-fold increased risk of cardiovascular death (HR 2.5, P < 0.05).
- This association remained significant and independent of traditional cardiovascular risk factors, eGFR, and albuminuria.
- A combination of low eGFR, albuminuria, and high u-CysC indicated a substantially higher cardiovascular mortality risk (HR 15, P < 0.001).
Conclusions:
- Increased urinary cystatin C (u-CysC) concentrations are an independent risk marker for cardiovascular death.
- u-CysC provides valuable prognostic information beyond established markers like eGFR and albuminuria.
- Further research is warranted to integrate u-CysC into clinical practice for cardiovascular risk assessment.
Objectives:
Urinary cystatin C (u-CysC) is a new biomarker for acute tubular kidney dysfunction and may also indicate chronic tubular dysfunction. Chronic kidney disease is an important cardiovascular risk factor, however it is not known if u-CysC is a risk marker for cardiovascular death.
Methods:
The association between u-CysC and cardiovascular mortality was investigated in a Swedish community-based cohort of 604 men aged 78 years. During follow-up (mean 6.7 years), 203 participants died, of which 90 due to cardiovascular causes.
Results:
High u-CysC (>0.029 mg/mmol Cr) was associated with a more than 2-fold risk of cardiovascular death (multivariable hazard ratio for quintile 5 vs. 1: 2.5, 95% CI 1.2-5.2, P < 0.05) in Cox regression models independent of cardiovascular risk factors, glomerular filtration rate (eGFR) and urinary Albumin. Participants with low eGFR (≤60 mL/min), albuminuria (≥3 mg/mmol Cr) and high u-CysC (>0.029 mg/mmol Cr) combined had a significantly higher cardiovascular mortality risk compared to participants with one or two of these biomarkers normal (hazard ratio 15, 95% CI: 6.7-36, P < 0.001, compared to all three biomarkers normal).
Conclusions:
This study is the first to show that increased concentrations of the tubular kidney biomarker u-CysC indicated risk of cardiovascular death independently of other cardiovascular risk factors, glomerular filtration and albuminuria. Additional research is needed to further establish the usefulness of u-CysC in clinical practice.
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