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Association Cystatin C and Risk of Stroke in Elderly Patients With Obstructive Sleep Apnea: A Prospective Cohort
Xiaofeng Su1,2, Yinghui Gao3, Weihao Xu4
1Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
Insights
Elevated Cystatin C (Cys-C) levels are a significant risk factor for stroke in elderly patients with obstructive sleep apnea (OSA). Higher Cys-C concentrations, particularly in those aged 70 and above, indicate an increased long-term stroke risk.
Area of Science:
- Gerontology
- Neurology
- Nephrology
Background:
- Obstructive sleep apnea (OSA) is prevalent in the elderly population.
- Few studies have prospectively investigated the link between Cystatin C (Cys-C) and stroke risk in elderly OSA patients.
- Cystatin C is a protein that may serve as a biomarker for kidney function and cardiovascular risk.
Purpose of the Study:
- To investigate the association between baseline serum Cys-C levels and the long-term risk of stroke in elderly patients diagnosed with OSA.
- To determine if Cys-C is an independent predictor of stroke in this specific demographic.
Main Methods:
- A prospective cohort study included 932 elderly patients (≥60 years) with OSA (apnea-hypopnea index ≥5 events/hour) and no prior stroke history.
- Serum Cys-C levels were measured at baseline and patients were categorized into quartiles.
- Multivariate Cox regression analysis was employed to assess the relationship between Cys-C and new-onset stroke, adjusting for confounders.
Main Results:
- A total of 61 strokes (54 ischemic, 7 hemorrhagic) occurred during a median follow-up of 42 months.
- Patients with higher baseline Cys-C (≥1.15 mg/L) exhibited a significantly higher cumulative incidence of stroke (Log-rank P < 0.001).
- Elevated Cys-C (≥1.15 mg/L) was independently associated with a 2.16-fold increased risk of stroke (HR 2.16, P=0.017), with a further increased risk observed in patients aged ≥70 years (HR 3.23, P=0.010). The predictive capability of Cys-C for stroke risk was moderate (AUC=0.731).
Conclusions:
- Increased serum Cys-C concentration is a significant, independent risk factor for stroke incidence in elderly patients with OSA.
- The risk of stroke associated with elevated Cys-C is particularly pronounced in individuals aged 70 years and older.
- Cys-C may serve as a valuable biomarker for identifying elderly OSA patients at higher risk of long-term stroke development.
Abstract:
Background: Few prospective cohort studies have assessed the relationship between Cystatin C (Cys-C) and risk of stroke in elderly patients with obstructive sleep apnea (OSA). The study sought to examine the association between baseline serum Cys-C and long-term risk of stroke among elderly OSA patients. Methods: A total of 932 patients with OSA, no history of stroke, ≥60 years of age, and complete serum Cys-C records were included in this study. All patients had completed polysomnography (PSG). OSA was defined as an apnea-hypopnea index (AHI) of ≥5 events per hour. Participants were categorized into four groups according to baseline serum Cys-C concentration, split into quartiles. Multivariate Cox regression were used to evaluate the association between Cys-C and the incidence of new-onset stroke. Results: Stroke occurred in 61 patients during the median 42-month follow-up period. The cumulative incidence rate of stroke was 6.5%, which included 54 patients with ischemic stroke and 7 patients with hemorrhagic stroke. The cumulative incidence of stroke was higher among patients with baseline serum Cys-C concentration of ≥1.15 mg/L when compared with other groups (P Log-rank < 0.001). After adjusting for potential confounding factors in the Cox regression model, patients with a serum Cys-C concentration of ≥1.15 mg/L had a 2.16-fold higher risk of developing stroke compared with patients with serum Cys-C ≤ 0.81 mg/L (HR, 2.16, 95%CI, 1.09-6.60; P = 0.017). Additionally, there was a higher risk in those of age ≥70 years (HR, 3.23, 95%CI, 1.05-9.24; P = 0.010). The receiver-operating characteristic curves showed that the capability of Cys-C to identify elderly patients with OSA who had a long-time risk of stroke was moderate (AUC = 0.731, 95% CI: 0.683-0.779, P = 0.001). Conclusion: Increased Cys-C concentration was identified as a risk factor in the incidence of stroke in elderly patients with OSA, independent of gender, BMI, hypertension and other risk factors. Additionally, it conferred a higher risk in patients of age ≥70 years.
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