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Received on August 23, 2004
Accepted on October 13, 2004
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
* To whom correspondence should be addressed. 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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  W. Koenig, C. Y. Vossen, Z. Mallat, H. Brenner, J. Benessiano, and D. Rothenbacher Association between type II secretory phospholipase A2 plasma concentrations and activity and cardiovascular events in patients with coronary heart disease Eur. Heart J., November 2, 2009; 30(22): 2742 - 2748. [Abstract] [Full Text] [PDF]
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 N. Taglieri, W. Koenig, and J. C. Kaski Cystatin C and Cardiovascular Risk Clin. Chem., November 1, 2009; 55(11): 1932 - 1943. [Abstract] [Full Text] [PDF]
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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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T. Keller, C. M. Messow, E. Lubos, V. Nicaud, P. S. Wild, H. J. Rupprecht, C. Bickel, S. Tzikas, D. Peetz, K. J. Lackner, et al. Cystatin C and cardiovascular mortality in patients with coronary artery disease and normal or mildly reduced kidney function: results from the AtheroGene study Eur. Heart J., February 1, 2009; 30(3): 314 - 320. [Abstract] [Full Text] [PDF]
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 M. S. MacGregor How common is early chronic kidney disease?: A Background Paper prepared for the UK Consensus Conference on Early Chronic Kidney Disease Nephrol. Dial. Transplant., September 1, 2007; 22(suppl_9): ix8 - ix18. [Full Text] [PDF]
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J. Lassus, V.-P. Harjola, R. Sund, K. Siirila-Waris, J. Melin, K. Peuhkurinen, K. Pulkki, M. S. Nieminen, and for the FINN-AKVA Study group Prognostic value of cystatin C in acute heart failure in relation to other markers of renal function and NT-proBNP Eur. Heart J., August 1, 2007; 28(15): 1841 - 1847. [Abstract] [Full Text] [PDF]
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 V. Menon, M. G. Shlipak, X. Wang, J. Coresh, T. Greene, L. Stevens, J. W. Kusek, G. J. Beck, A. J. Collins, A. S. Levey, et al. Cystatin C as a Risk Factor for Outcomes in Chronic Kidney Disease Ann Intern Med, July 3, 2007; 147(1): 19 - 27. [Abstract] [Full Text] [PDF]
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 W. Koenig, D. Twardella, H. Brenner, and D. Rothenbacher Lipoprotein-Associated Phospholipase A2 Predicts Future Cardiovascular Events in Patients With Coronary Heart Disease Independently of Traditional Risk Factors, Markers of Inflammation, Renal Function, and Hemodynamic Stress Arterioscler Thromb Vasc Biol, July 1, 2006; 26(7): 1586 - 1593. [Abstract] [Full Text] [PDF]
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M. von Eynatten, A. Hamann, D. Twardella, P. P. Nawroth, H. Brenner, and D. Rothenbacher Relationship of Adiponectin with Markers of Systemic Inflammation, Atherogenic Dyslipidemia, and Heart Failure in Patients with Coronary Heart Disease Clin. Chem., May 1, 2006; 52(5): 853 - 859. [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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