| Authors | Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, Siscovick DS, Stehman-Breen C. | |
| Title | Cystatin
C and the risk of death and cardiovascular events among elderly persons. |
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| Full source | N Engl J Med. 2005 May 19;352(20):2049-60. | |
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 Per scorrere le diapositive |
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| Abstract | BACKGROUND:
Cystatin C is a serum measure of renal function that appears to be independent
of age, sex, and lean muscle mass. We compared creatinine and cystatin C
levels as predictors of mortality from cardiovascular causes and from all
causes in the Cardiovascular Health Study, a cohort study of elderly persons
living in the community. METHODS: Creatinine and cystatin C were measured
in serum samples collected from 4637 participants at the study visit in
1992 or 1993; follow-up continued until June 30, 2001. For each measure,
the study population was divided into quintiles, with the fifth quintile
subdivided into thirds (designated 5a, 5b, and 5c). RESULTS: Higher cystatin
C levels were directly associated, in a dose-response manner, with a higher
risk of death from all causes. As compared with the first quintile, the
hazard ratios (and 95 percent confidence intervals) for death were as follows:
second quintile, 1.08 (0.86 to 1.35); third quintile, 1.23 (1.00 to 1.53);
fourth quintile, 1.34 (1.09 to 1.66); quintile 5a, 1.77 (1.34 to 2.26);
5b, 2.18 (1.72 to 2.78); and 5c, 2.58 (2.03 to 3.27). In contrast, the association
of creatinine categories with mortality from all causes appeared to be J-shaped.
As compared with the two lowest quintiles combined (cystatin C level, <
or =0.99 mg per liter), the highest quintile of cystatin C (> or =1.29
mg per liter) was associated with a significantly elevated risk of death
from cardiovascular causes (hazard ratio, 2.27 [1.73 to 2.97]), myocardial
infarction (hazard ratio, 1.48 [1.08 to 2.02]), and stroke (hazard ratio,
1.47 [ 1.09 to 1.96]) after multivariate adjustment. The fifth quintile
of creatinine, as compared with the first quintile, was not independently
associated with any of these three outcomes. CONCLUSIONS: Cystatin C, a
serum measure of renal function, is a stronger predictor of the risk of
death and cardiovascular events in elderly persons than is creatinine. |
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