Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Clin Cardiol. 2009 Nov;32(11):E18-22. doi: 10.1002/clc.20465.
Elevated concentrations of cystatin C are associated with greater cardiovascular morbidity and mortality. We sought to determine whether elevated concentrations of cystatin C were associated with inducible ischemia in patients with coronary heart disease (CHD).
We measured serum cystatin C and performed exercise treadmill testing with stress echocardiography in a cross-sectional study of 899 outpatients with CHD.
Among the 241 participants in the highest quartile of cystatin C (>1.30 mg/L), 38% had inducible ischemia, compared with 13% of those in the lowest quartile of cystatin C < 0.92 mg/L; adjusted odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.2 to 3.8; p = 0.01). However, this association differed in participants with and without a history of coronary artery bypass graft (CABG), as well as in users and nonusers of beta-blockers and statins (p values for interaction < 0.1). Among participants without a history of CABG, 35% of those in the highest quartile and 9% of those in the lowest quartile of cystatin C had inducible ischemia (adjusted OR: 3.05; 95% CI: 1.3-6.9; p = 0.008). Among participants who were not using beta-blockers, 44% of those in the highest quartile and 7% in the lowest quartile of cystatin C had inducible ischemia (adjusted OR: 5.3; 95% CI: 1.8-15.5; p = 0.002). Among participants who were not using statins, 39% of participants in the highest quartile and 4% of those in the lowest quartile had inducible ischemia (adjusted OR: 10.3; 95% CI: 2.5-43.3; p = 0.001).
Elevated levels of cystatin C are independently associated with inducible ischemia among outpatients with stable coronary disease.
半胱氨酸蛋白酶抑制剂 C 浓度升高与心血管发病率和死亡率增加相关。我们旨在确定胱抑素 C 浓度升高是否与冠心病（CHD）患者的可诱导缺血相关。
我们对 899 名冠心病门诊患者进行了一项横断面研究，测量了血清胱抑素 C 浓度并进行了运动平板试验联合超声心动图负荷试验。
在胱抑素 C 最高四分位数（>1.30mg/L）的 241 名参与者中，有 38%存在可诱导缺血，而胱抑素 C 最低四分位数（<0.92mg/L）的参与者中仅有 13%存在可诱导缺血；调整后的比值比[OR]：2.1；95%置信区间[CI]：1.2 至 3.8；p = 0.01）。然而，这种关联在有或无冠状动脉旁路移植术（CABG）病史的患者中以及β受体阻滞剂和他汀类药物使用者和非使用者中存在差异（交互检验 p 值 < 0.1）。在无 CABG 病史的参与者中，胱抑素 C 最高四分位数组有 35%存在可诱导缺血，而最低四分位数组仅有 9%存在可诱导缺血（调整后的 OR：3.05；95% CI：1.3-6.9；p = 0.008）。在未使用β受体阻滞剂的参与者中，胱抑素 C 最高四分位数组有 44%存在可诱导缺血，而最低四分位数组仅有 7%存在可诱导缺血（调整后的 OR：5.3；95% CI：1.8-15.5；p = 0.002）。在未使用他汀类药物的参与者中，胱抑素 C 最高四分位数组有 39%存在可诱导缺血，而最低四分位数组仅有 4%存在可诱导缺血（调整后的 OR：10.3；95% CI：2.5-43.3；p = 0.001）。
在稳定型冠心病门诊患者中，胱抑素 C 水平升高与可诱导缺血独立相关。
