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Cystatin C-based eGFR predicts cardiovascular disease in patients with overweight/obesity and hyperglycemia
Keita Suzuki1,2, Hiromasa Tsujiguchi2, Akinori Hara2
1Department of Endocrinology and Metabolism Kanazawa University Graduate School of Medical Sciences Kanazawa Ishikawa Japan.
Insights
In overweight and obese patients with high blood sugar, lower cystatin C-based estimated glomerular filtration rate (eGFRcys) predicts cardiovascular disease (CVD) risk more accurately than creatinine-based eGFR (eGFRcr). Declining eGFRcys levels over time also indicate increased CVD development.
Area of Science:
- Nephrology
- Cardiology
- Metabolic Syndrome
Background:
- Obesity presents unique challenges in predicting cardiovascular disease (CVD).
- Existing CVD predictors may not be accurate for individuals with obesity.
- Obesity-related pathophysiology requires exploration of novel risk factors.
Purpose of the Study:
- To identify a more accurate predictor of CVD in overweight and obese patients.
- To investigate the role of kidney function markers in CVD development within this population.
- To explore the interaction between obesity, hyperglycemia, and CVD risk.
Main Methods:
- Analysis of 318 outpatients from the Japan Obesity and Metabolic Syndrome study.
- Categorization based on fasting plasma glucose (FPG): high FPG (HFPG) and normal FPG (NFPG).
- Cox proportional hazards models and generalized linear mixed models used to assess CVD predictors and eGFR changes over 5 years.
Main Results:
- In the HFPG group, lower cystatin C-based estimated glomerular filtration rate (eGFRcys) was significantly associated with CVD development, unlike creatinine-based eGFR (eGFRcr).
- Patients with HFPG showed a greater reduction in eGFRcys levels over time compared to those with NFPG.
- A decline in eGFRcys levels was observed in patients who developed CVD, but not in matched non-CVD patients.
Conclusions:
- Lower eGFRcys is a more accurate predictor of CVD in overweight/obese patients with hyperglycemia than eGFRcr.
- Progressive reduction in eGFRcys over time is linked to CVD development in this cohort.
- This highlights the importance of monitoring eGFRcys in managing CVD risk in obese individuals with hyperglycemia.
Background:
Although many clinical parameters have been identified as predictors for cardiovascular disease (CVD) development in the general population, the accurate predictor for CVD in patients with obesity is still unknown.
Objective:
The study aimed to explore an additional risk factor and predictor for CVD in patients with overweight/obesity considering the interaction of obesity-related pathophysiology.
Methods:
The Japan Obesity and Metabolic Syndrome study, a multicenter prospective study, enrolled 787 outpatients, of which 318 eligible patients were analyzed. Patients with fasting plasma glucose (FPG) levels ≥6.11 and < 6.11 mmol/L were considered to have high FPG (HFPG) and normal FPG (NFPG), respectively. Thirty-six patients who developed CVD during the 5 years follow-up were assigned to the CVD group.
Results:
Cox's proportional hazards model revealed no significant association between CVD and cystatin C-based estimated glomerular filtration rate (eGFRcys) or creatinine-based eGFR (eGFRcr) in the NFPG group. In the HFPG group, lower eGFRcys, but not eGFRcr, was significantly associated with CVD development. A generalized linear mixed model demonstrated greater reduction in eGFRcys levels over time with HFPG than with NFPG. Although the CVD group showed gradual reduction in eGFRcys levels, the non-CVD group-matched using propensity scores-did not show a decline in eGFRcys levels.
Conclusions:
Lower eGFRcys levels may be more accurate than eGFRcr in predicting CVD development in patients with overweight/obesity and hyperglycemia. Furthermore, eGFRcys reduction over time is associated with CVD development.
Clinical Trial Registry Number:
UMIN000000559.
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