Cystatin C for Enhancement of Risk Stratification in Non–ST Elevation Acute Coronary Syndrome Patients with an Increased Troponin T

Windhausen, Fons; Hirsch, Alexander; Fischer, Johan; Zee, P. Marc van der; Sanders, Gerard T.; Straalen, Jan P. van; Cornel, Jan H.; Tijssen, Jan G.P.; Verheugt, Freek W.A.; Winter, Robbert J. de

doi:10.1373/clinchem.2008.119669

Cited by 37 publications

(35 citation statements)

References 24 publications

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“…Recently, these observations have been confirmed and expanded by investigators in the ICTUS (Invasive vs Conservative Treatment in Unstable Coronary Syndromes) trial, in which Windhausen et al found that in patients with NSTE-ACS and increased cardiac troponin T concentrations, high plasma cystatin C concentrations are associated with a higher risk of death and spontaneous MI (38 ).…”

Section: Findings In Acute Coronary Syndrome Patientsmentioning

confidence: 82%

Cystatin C and Cardiovascular Risk

2009

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Background: Patients with chronic kidney disease (CKD) are at high risk for developing cardiovascular disease (CVD) and cardiovascular events. Cystatin C, a protease inhibitor synthesized in all nucleated cells, has been proposed as a replacement for serum creatinine for the assessment of renal function, particularly to detect small reductions in glomerular filtration rate. Content: This report presents a review of the role of cystatin C as a predictor of cardiovascular risk. Summary: Patients with higher circulating cystatin C concentrations appear to have an increased cardiovascular risk profile, i.e., they are older and have a higher prevalence of systemic hypertension, dyslipidemia, documented CVD, increased body mass index, and increased concentrations of C-reactive protein. Prospective studies have shown, in various clinical scenarios, that patients with increased cystatin C are at a higher risk of developing both CVD and CKD. Importantly, cystatin C appears to be a useful marker for identifying individuals at a higher risk for cardiovascular events among patients belonging to a relatively low-risk category as assessed by both creatinine and estimated glomerular filtration rate values. Of interest, elastolytic proteases and their inhibitors, in particular cystatin C, have been shown to be directly involved in the atherosclerotic process. Increased concentrations of cystatin C appear to be indicative of preclinical kidney disease associated with adverse outcomes. Clinical studies involving direct glomerular filtration rate measurements are required to ascertain both the true role of this promising marker in renal disease and whether atherogenic factors like inflammation can account for increases in cystatin C concentrations, thus explaining its predictive value in CVD.

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Section: Findings In Acute Coronary Syndrome Patientsmentioning

confidence: 82%

Cystatin C and Cardiovascular Risk

2009

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“…[25][26][27] Moreover, increased cystatin C was associated with all-cause, cardiovascular, and even non-cardiovascular mortality in a population-based cohort of subjects with normal kidney function. 28 However, whether cystatin C merely reflects the association of mildly impaired kidney function with increased risk of cardiovascular disease, or is an independent risk factor involved in the pathogenesis of atherosclerosis, has not been fully elucidated.…”

Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 97%

Cystatin C is associated with risk of venous thromboembolism in subjects with normal kidney function - the Tromso study

Brodin¹,

Brækkan²,

Vik³

et al. 2012

Haematologica

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BackgroundPrevious studies have shown an association between impaired kidney function, assessed by cystatin C-based estimated glomerular filtration rate, and venous thromboembolism. The aim of this study was to investigate whether serum cystatin C was associated with a risk of venous thromboembolism among subjects with normal kidney function in a prospective population-based study. Design and MethodsCystatin C was measured in serum from 3251 men and women with normal kidney function, aged 25-84 years, who participated in the Tromsø study in 1994-1995. Normal kidney function was defined as a creatinine-based estimated glomerular filtration rate greater than 90 mL/min/1.73 m 2 and absence of microalbuminuria. Incident venous thromboembolism was registered from the date of inclusion through to the end of follow-up, September 1, 2007. Cox-regression models were used to calculate hazard ratios with 95% confidence intervals for venous thromboembolism. ResultsThere were 83 incident venous thromboembolic events, of which 53 (63.9 %) were provoked, during a median of 12.3 years of follow-up. A one standard deviation (0.11 mg/L) increase in serum cystatin C levels was associated with a 43% (hazard ratio 1.43; 95% confidence interval 1.17-1.72) increased risk of total venous thromboembolism. Subjects with cystatin C levels in the top quartile (≥0.87 mg/L) had a 2.5-fold (hazard ratio 2.51; 95% confidence interval 1.27-4.96) increased risk of venous thromboembolism compared to those with levels in the bottom quartile (≤0.72 mg/L) in adjusted analysis. The risk estimates were even higher for provoked venous thromboembolism (hazard ratio 3.11; 95% confidence interval 1.23-7.86). ConclusionsSerum cystatin C levels were associated with the risk of venous thromboembolism in subjects with normal kidney function. Our findings suggest that elevated serum cystatin C levels may promote venous thrombosis beyond reflecting impaired kidney function.Key words: cystatin C, venous thromboembolism, VTE, risk. 2012;97(7):1008-1013. doi:10.3324/haematol.2011 Cystatin C is associated with risk of venous thromboembolism in subjects with normal kidney function -the Tromsø study Citation: Brodin EE, Braekkan SK, Vik A, Brox J, and Hansen J-B. Cystatin C is associated with risk of venous thromboembolism in subjects with normal kidney function -the Tromsø study. Haematologica ABSTRACT© F e r r a t a S t o r t i F o u n d a t i o n

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“…Even a small decrease in GFR estimated by C-G, MDRD, or cystatin C is associated with an increased risk for death and cardiovascular disease (7,8,(11)(12)(13)(14)(15)(16)(17). Concentrations of cystatin C have been related to both mortality and myocardial infarction rates in a non-STelevation acute coronary syndrome (NSTE-ACS) population (16 ).…”

confidence: 99%