Cystatin C

Abstract

Background-Patients with suspected or confirmed non-ST-elevation acute coronary syndrome (ACS) constitute a large and heterogeneous group. Measurements of renal function such as serum creatinine and estimation of creatinine clearance carry independent prognostic information in this population. Cystatin C is a new and better marker of renal function than creatinine. The aim was therefore to evaluate the prognostic value of cystatin C in this population. Methods and Results-Cystatin C was analyzed on admission in 726 patients admitted because of symptoms suggestive of an acute coronary syndrome and no ST-segment elevations. Patients were followed up with regard to death and myocardial infarction for a median of 40 and 6 months, respectively. The median cystatin C level was 1.00 mg/L (25th to 75th percentile, 0.83 to 1.24 mg/L). The risk of death during follow-up increased with increasing levels of cystatin C. In the group with non-ST-elevation ACS, patients in the second, third, and fourth quartiles had a relative risk of subsequent death of 1.8 (95% CI, 0.6 to 5.3), 3.2 (95% CI, 1.2 to 8.5), and 11.7 (95% CI, 4.7 to 29.3) compared with the lowest quartile. In Cox regression models including well-known predictors of outcome, cystatin C level was independently associated with mortality but not with the risk of subsequent myocardial infarction. In a comparison of the markers of renal function in receiver-operating curve analyses, cystatin C had the best ability to discriminate between survivors and nonsurvivors. Conclusions-A single measurement of cystatin C will substantially improve the early risk stratification of patients with suspected or confirmed non-ST-elevation ACS.

Cystatin C: current position and future prospects

“…Retrospective studies on existing cohorts very rapidly extended these findings to the entire population and in particular to the elderly. CysC was significantly associated with all cause mortality (209,(217)(218)(219)(220)(221)(222)(223), cardiovascular mortality (209, 217-219, 222, 223), myocardial infarction (209,224), cerebrovascular accident (209,225) and peripheral arterial disease (226). Whilst the association with all cause or cardiovascular mortality was found systematically, other authors failed to find relationships between CysC concentrations and non-coronary vascular accidents (218) mostly in middle-aged men (227).…”

“…Whilst the association with all cause or cardiovascular mortality was found systematically, other authors failed to find relationships between CysC concentrations and non-coronary vascular accidents (218) mostly in middle-aged men (227). These relationships between cardiovascular disease and increased CysC concentrations have been described both in cohorts or sub-groups of patients selected on the basis of a past history of cardiovascular disease (216,217,219,221,225,226) and in patients without cardiovascular history (220, 222-224, 228, 229). Some also consider that increased CysC values may be associated with morphological cardiac abnormalities, such as left ventricular hypertrophy or left ventricular dysfunction on echocardiography (228), functional abnormalities, such as heart failure (230), or poor exercise tolerance (231).…”

Lipoprotein‐Associated Phospholipase A 2 Activity Is a Marker of Risk But Not a Useful Target for Treatment in Patients With Stable Coronary Heart Disease

“…Biomarkers indicating myocardial dysfunction (eg, troponin, natriuretic peptides), renal dysfunction (eg, cystatin C), and inflammatory activity (eg, C‐reactive protein) are risk indicators of future cardiovascular events in healthy persons and in patients with established coronary heart disease (CHD) 2, 3, 4, 5. Higher levels of lipoprotein‐associated phospholipase A 2 (Lp‐PLA 2 ) activity have also been associated with an increased risk of coronary events in healthy elderly persons and in patients with stable CHD 6, 7, 8, 9.…”

Association of Cystatin C With Poor Exercise Capacity and Heart Rate Recovery: Data From the Heart and Soul Study

“…[2][3][4][5] The distinction between the 2 filtrating markers is pronounced in persons with eGFR greater than 60 mL/min (>1.00 mL/s); cystatin C level retains a strong association with cardiovascular risk in persons with eGFR greater than 60 mL/min (>1.00 mL/s), whereas creatinine level and eGFR have no significant association. 21 We previously showed that CKD, defined as creatinine clearance less than 60 mL/min (<1.00 mL/s), was associated with a 6-fold odds of poor exercise capacity in the Heart and Soul cohort compared with the highest creatinine clearance.…”

“…1 Increased serum cystatin C levels predict cardiovascular outcomes in outpatients with and without known coronary heart disease (CHD) and in patients presenting with acute coronary syndromes. [2][3][4][5][6] Cystatin C has a more linear association with cardiovascular mortality and adverse events than creatinine-based measurements. 5 A recent study defined elderly persons with increased cystatin C levels and estimated glomerular filtration rate (eGFR) greater than 60 mL/min (>1.00 mL/s) as having preclinical kidney disease and found this group to have increased risks of cardiovascular disease and incident chronic kidney disease (CKD).…”