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Proteomics and Protein Markers |
1 Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany
2 Department of Epidemiology, German Centre for Research on Ageing, University of Heidelberg, Heidelberg, Germany.
aAddress correspondence to this author at: Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Robert-Koch-Strasse 8, D-89081 Ulm, Germany. Fax 49-731-500-33872; e-mail wolfgang.koenig{at}medizin.uni-ulm.de.
Background: Renal impairment (RI) is associated with worse prognosis. Recently, cystatin C has been shown to represent a potentially superior marker of the glomerular filtration rate compared with creatinine clearance (CrCl). We evaluated the impact of cystatin C and other markers of RI on prognosis in a large cohort of patients with coronary heart disease (CHD).
Methods: Cystatin C, creatinine (Cr), and CrCl were determined at baseline in a cohort of 1033 patients (30–70 years) with CHD. Patients were followed for a mean of 33.5 months, and a combined endpoint [fatal and nonfatal cardiovascular disease (CVD) events] was used as the outcome variable. Cystatin C was measured by immunonephelometry, and CrCl was calculated.
Results: During follow-up, 71 patients (6.9%) experienced a secondary CVD event. Neither Cr (P = 0.63) nor CrCl (P = 0.10) were associated with incidence of CVD events, whereas cystatin C was clearly associated with risk of secondary CVD events (P <0.0001). In multivariate analyses, patients in the top quintile of the cystatin C distribution at baseline had a statistically significantly increased risk of secondary CVD events even after adjustment for classic risk factors, severity of coronary disease, history of diabetes mellitus, treatment with angiotensin-converting enzyme inhibitors, and C-reactive protein (hazard ratio, 2.27; 95% confidence interval, 1.05–4.91) compared with patients in the bottom quintile.
Conclusions: These data support the possibly important prognostic value of cystatin C among patients with known CHD and suggest that it may be a useful clinical marker providing complementary information to established risk determinants.
The following articles in journals at HighWire Press have cited this article:
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  P. C. Patel, C. R. Ayers, S. A. Murphy, R. Peshock, A. Khera, J. A. de Lemos, J. A. Balko, S. Gupta, P. P.A. Mammen, M. H. Drazner, et al. Association of Cystatin C With Left Ventricular Structure and Function: The Dallas Heart Study Circ Heart Fail, March 1, 2009; 2(2): 98 - 104. [Abstract] [Full Text] [PDF]
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M. Loew, M. M. Hoffmann, W. Koenig, H. Brenner, and D. Rothenbacher Genotype and Plasma Concentration of Cystatin C in Patients With Coronary Heart Disease and Risk for Secondary Cardiovascular Events Arterioscler. Thromb. Vasc. Biol., July 1, 2005; 25(7): 1470 - 1474. [Abstract] [Full Text] [PDF]
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A. Levin Cystatin C, Serum Creatinine, and Estimates of Kidney Function: Searching for Better Measures of Kidney Function and Cardiovascular Risk Ann Intern Med, April 5, 2005; 142(7): 586 - 588. [Full Text] [PDF]
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G. Curhan Cystatin C: A Marker of Renal Function or Something More? Clin. Chem., February 1, 2005; 51(2): 293 - 294. [Full Text] [PDF]
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