Christopher Odong, Xu Xing-Feng, Lin Yi-Fen, Zhang Shao-Zhao, Huang Yi-Quan, Zhong Xiang-Bin, Xiong Zhen-Yu, Chen Tara Scarlett Rosalyn, Xu Chao-Guang, Zhuang Xiao-Dong, Liao Xin-Xue
Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
J Geriatr Cardiol. 2021 Dec 28;18(12):986-995. doi: 10.11909/j.issn.1671-5411.2021.12.003.
Cystatin C (CysC) is a cysteine protease inhibitor involved in proteins catabolism and plays an essential role in human vascular pathophysiology. CysC may also increase the risk of aortic stenosis (AS), but limited studies have reported on this association. This study aimed to investigate if elevated serum CysC levels are associated with hemodynamically significant AS.
Serum CysC levels were estimated in 4,791 participants, samples were collected in 1990-1992. The study population was divided into quintile groups. Follow-up continued in 2011-2013 when participants returned for echocardiography examination. Incidence of aortic valve disease (AVD) was ascertained by Doppler echocardiography through the end of 2013. AVD defined in hemodynamic progression was assessed and classified as aortic sclerosis, mild stenosis, and moderate-to-severe stenosis.
Overall, a total of 4,791 participants (mean age: 54.8 ± 5.0 years, females: 57.6%, blacks: 8.2%) were included in this study. During a follow-up of 21 years, we identified 736 cases (15.4%) of aortic sclerosis, 194 cases (4.0%) of mild stenosis, and 42 cases (0.7%) of moderate-to-severe stenosis. Compared with serum CysC levels within individual quintile groups, the odds ratio (OR) was per standard deviation associated with an increased incidence of AVD (OR = 1.15, 95% CI: 1.05-1.26, = 0.002).
In this large population-based study, an increased serum CysC levels is independently associated with the incidence of hemodynamically significant AS. However, this association appears not to extend to patients with extremely high serum CysC levels and necessitate further investigation.
胱抑素C（CysC）是一种参与蛋白质分解代谢的半胱氨酸蛋白酶抑制剂，在人类血管病理生理学中起重要作用。CysC也可能增加主动脉瓣狭窄（AS）的风险，但关于这种关联的研究报道有限。本研究旨在调查血清CysC水平升高是否与血流动力学显著的AS相关。
对1990 - 1992年收集的4791名参与者的血清CysC水平进行评估。研究人群被分为五分位组。2011 - 2013年参与者返回进行超声心动图检查时继续随访。通过多普勒超声心动图确定截至2013年底的主动脉瓣疾病（AVD）发病率。评估血流动力学进展中定义的AVD，并分类为主动脉硬化、轻度狭窄和中重度狭窄。
总体而言，本研究共纳入4791名参与者（平均年龄：54.8±5.0岁，女性：57.6%，黑人：8.2%）。在21年的随访期间，我们确定了736例（15.4%）主动脉硬化病例、194例（4.0%）轻度狭窄病例和42例（0.7%）中重度狭窄病例。与各五分位组内的血清CysC水平相比，每标准差的比值比（OR）与AVD发病率增加相关（OR = 1.15，95%CI：1.05 - 1.26，P = 0.002）。
在这项基于人群的大型研究中，血清CysC水平升高与血流动力学显著的AS发病率独立相关。然而，这种关联似乎并不延伸至血清CysC水平极高的患者，需要进一步研究。
