Keller Till, Messow Claudia Martina, Lubos Edith, Nicaud Viviane, Wild Philipp S, Rupprecht Hans J, Bickel Christoph, Tzikas Stergios, Peetz Dirk, Lackner Karl J, Tiret Laurence, Münzel Thomas F, Blankenberg Stefan, Schnabel Renate B
Department of Medicine II, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.
Eur Heart J. 2009 Feb;30(3):314-20. doi: 10.1093/eurheartj/ehn598. Epub 2009 Jan 19.
Chronic kidney disease is associated with increased risk of cardiovascular disease. Cystatin C is a promising marker to reliably mirror renal function. The role of cystatin C in patients with coronary artery disease (CAD) and normal or mildly reduced kidney function is the subject of current investigation.
In 2162 patients, over the whole spectrum of CAD, baseline cystatin C concentrations were measured. Patients with an estimated glomerular filtration rate of < or =60 mL/min per 1.73 m(2) (n = 295) were excluded. In patients with complete follow-up information (n = 1827), 66 cardiovascular deaths were registered during a median follow-up of 3.65 years. Logarithmically transformed, standardized cystatin C was associated with cardiovascular death [hazard ratio: 1.94, 95% confidence interval (CI): 1.59-2.37, P < 0.001]. A potential threshold effect was observed; patients in the upper quartile had a 3.87-fold (95% CI: 2.33-6.42; P < 0.001) risk of mortality compared with the pooled lower quartiles. This risk association remained robust after adjustment for potential confounders including classical risk factors and N-terminal pro B-type natriuretic peptide. Serum creatinine was not associated with the outcome in this group of patients with normal renal function.
Results of this prospective study show that cystatin C is a potent predictor of cardiovascular mortality beyond classical risk factors in patients with CAD and normal or mildly reduced kidney function.
慢性肾脏病与心血管疾病风险增加相关。胱抑素C是可靠反映肾功能的一个有前景的标志物。胱抑素C在冠状动脉疾病（CAD）且肾功能正常或轻度降低患者中的作用是当前研究的主题。
在2162例涵盖整个CAD谱的患者中，测量了基线胱抑素C浓度。估算肾小球滤过率<或=60 ml/min per 1.73 m²的患者（n = 295）被排除。在有完整随访信息的患者（n = 1827）中，在中位随访3.65年期间记录到66例心血管死亡。经对数转换和标准化后的胱抑素C与心血管死亡相关[风险比：1.94，95%置信区间（CI）：1.59 - 2.37，P < 0.001]。观察到一种潜在的阈值效应；与合并的较低四分位数相比，上四分位数的患者死亡风险高3.87倍（95% CI：2.33 - 6.42；P < 0.001）。在对包括经典危险因素和N末端B型利钠肽原在内的潜在混杂因素进行调整后，这种风险关联仍然稳健。血清肌酐与该组肾功能正常患者的结局无关。
这项前瞻性研究的结果表明，在CAD且肾功能正常或轻度降低的患者中，胱抑素C是超出经典危险因素的心血管死亡的有力预测指标。
