The association between cystatin C and hypertension risk in diabetes patients: A multi-cohort cross-sectional study

Area of Science:

• Nephrology
• Endocrinology
• Cardiology

Background:

• Diabetes mellitus with hypertension (DM + HTN) significantly increases cardiovascular risks.
• Predictors for the combined condition of DM + HTN are not fully understood.
• Early identification of individuals at risk is crucial for cardiovascular event prevention.

Purpose of the Study:

• To identify novel predictors for the development of hypertension in patients with diabetes mellitus.
• To develop and validate a risk prediction model for DM + HTN incorporating identified predictors.
• To assess the clinical utility of the developed risk prediction model.

Main Methods:

• Analysis of data from 5210 diabetes mellitus patients across three cohorts.
• Univariate and multivariate logistic regression analyses to identify risk factors.
• Development of a risk prediction model including serum cystatin C (CysC) and other covariates.
• Model performance evaluation using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).
• Exploration of nonlinear relationships using restricted cubic spline analysis.
• Validation using 10 machine learning algorithms and interpretation with SHapley Additive exPlanations (SHAP).

Main Results:

• Serum cystatin C (CysC) was identified as an independent risk factor for DM + HTN.
• A risk prediction model incorporating CysC demonstrated good predictive performance and clinical utility.
• A nonlinear relationship was observed between CysC levels and DM + HTN risk, with elevated risk above 0.94 mg/L.
• Machine learning algorithms and SHAP analysis further supported the model's predictive power and interpretability.

Conclusions:

• Serum cystatin C is a valuable biomarker for predicting hypertension in diabetes patients.
• A CysC-based risk prediction model can assist clinicians in the early identification of high-risk individuals.
• This model facilitates timely intervention strategies to mitigate cardiovascular risks associated with DM + HTN.