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Association between the difference in estimated GFR based on cystatin C versus creatinine in coronary artery diseases
Zechen Liu1,2, Wangying Jiang1,2, Yanjun Song1,2
1Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
Insights
The difference in estimated glomerular filtration rate (eGFR) between creatinine and cystatin C measurements is linked to coronary artery disease (CAD) risk. Higher eGFR differences indicate a lower risk of developing CAD, independent of genetic factors.
Area of Science:
- Nephrology
- Cardiology
- Biomarkers
Background:
- The difference between creatinine-based and cystatin C-based estimated glomerular filtration rate (eGFRdiff) is a recent finding.
- While eGFRdiff is linked to poor cardiovascular prognosis, its role in primary prevention of coronary artery disease (CAD) is understudied.
Purpose of the Study:
- To investigate the association between eGFRdiff and the risk of incident coronary artery disease (CAD) in individuals without prior CAD.
- To determine if this association is influenced by genetic susceptibility to CAD.
Main Methods:
- A prospective cohort study using UK Biobank data from 437,536 participants without baseline CAD.
- eGFRdiff calculated by subtracting creatinine-eGFR from cystatin C-eGFR, categorized into negative, intermediate, and positive groups.
- Cox proportional risk models analyzed associations of eGFRdiff with CAD incidence over a median follow-up of 13.8 years.
Main Results:
- During follow-up, 36,797 incident CAD cases were recorded.
- Compared to the intermediate group, a positive eGFRdiff was associated with lower CAD risk (HR 0.717), while a negative eGFRdiff was associated with higher CAD risk (HR 1.433).
- Increasing eGFRdiff showed a continuous trend of decreasing CAD risk (HR 0.982), independent of genetic susceptibility.
Conclusions:
- eGFRdiff is significantly associated with coronary artery disease (CAD) risk.
- A higher eGFRdiff is linked to a reduced likelihood of CAD onset, irrespective of an individual's genetic predisposition to the disease.
Background:
The difference in estimated glomerular filtration rate (eGFR) derived from creatinine and cystatin C (eGFRdiff) has been noticed recently and the relationship with poor cardiovascular prognosis has been proven. However, primary prevention of the risk of coronary artery disease (CAD) is equally important but there is a lack of studies specifically investigating this implication.
Methods:
This prospective cohort study utilized data from the UK Biobank, including 437,536 participants without CAD at baseline. The primary outcome was defined as CAD. The eGFRdiff was calculated by subtracting creatinine-based eGFR from cystatin C-based eGFR. Participants were then categorized into a negative, intermediate range, and positive group based on thresholds of -15 mL/min/1.73 m2 and 15 mL/min/1.73 m2. Cox proportional risk models were used to evaluate the associations of eGFRdiff with CAD and the relationship among different genetic risks of CAD.
Results:
During a median follow-up of 13.8 years, CAD occurred in 36,797 participants. In the fully adjusted model, compared to midrange eGFRdiff, participants with a positive eGFRdiff had a lower risk of CAD (HR 0.717, 95%CI 0.675-0.762), while with a negative eGFRdiff had a higher risk (HR 1.433, 95%CI 1.399-1.468). When eGFRdiff was treated as a continuous variable, a statistically significant trend toward a lower risk of CAD as eGFRdiff increased (HR 0.982, 95% CI 0.981-0.982). Moreover, this relationship is independent of genetic susceptibility.
Conclusions:
eGFRdiff was associated with CAD risk, where a high eGFRdiff corresponded to a decreased likelihood of CAD onset no matter genetic susceptibility.
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