Cystatin C predicts the risk of incident cerebrovascular disease in the elderly

Abstract

Background: Stroke is the third leading cause of global year of life lost in all-age and second-ranked cause of disability adjusted life years in middle-aged and elder population. Therefore, it is critical to study the relationship between vascular-related risk factors and cerebrovascular diseases. Several cross-sectional studies have shown that Cystatin C (Cys C) is an independent risk factor for cerebrovascular diseases and levels of Cys C are significantly higher in stroke patients than in healthy individuals. In this meta-analysis, we introduce a Cox proportional hazards model to evaluate the causality between Cys C and the risk of cerebrovascular accident in the elderly. Methods: We searched PubMed, EMBASE, the Web of Science, and the Cochrane Library from 1985 to 2019 for studies on the relationship between serum Cys C and incidence stroke with Cox proportional hazards models. We conducted a subgroup analysis of the selected studies to determine a connection between atherosclerosis and stroke. Finally, 7 research studies, including 26,768 patients without a history of cerebrovascular, were studied. Results: After comparing the maximum and minimum Cys C levels, the hazard ratio for all types of stroke, including ischemic and hemorrhagic stroke, was 1.18 (95% confidence interval 1.04–1.31) with moderate heterogeneity ( I 2 = 43.0%; P = .119) in a fixed-effect model after pooled adjustment for other potential risk factors. In the subgroup analysis, the hazard ratio and 95% confidence interval for Cys C stratified by atherosclerosis was 1.85 (0.97–2.72). As shown in Egger linear regression test, there was no distinct publication bias ( P = .153). Conclusion: Increased serum Cys C is significantly associated with future stroke events in the elderly, especially in patients with carotid atherosclerosis. Thus, serum levels of Cys C could serve as a predicted biomarker for stroke attack.

Lower serum cystatin C level predicts poor functional outcome in patients with hypertensive intracerebral hemorrhage independent of renal function

“…CysC, an endogenous inhibitor of cysteine proteinase, is highly associated with cerebrovascular events. 12 , 24 , 25 There are several key findings of the present study. Firstly, serum CysC level showed a negative association with poor functional outcome in patients with HICH independent of chronic kidney function (eGFR < 60 mL/min/1.73 m2).…”

“…CysC, an endogenous inhibitor of cysteine proteinase, is highly associated with cerebrovascular events 12,24,25 . There are several key findings of the present study.…”

“…It was shown to be superior to serum creatinine (sCr) as a biomarker of early kidney dysfunction in clinical settings 8,9 . In addition, serum CysC was shown to be a stronger predictor of the risk of cardiovascular and cerebrovascular events in older persons compared to sCr 10–12 . Serum CysC also showed an independent association with cerebral artery stenosis and mortality in patients with stroke or cardiovascular disease who did not have chronic kidney disease (CKD) 13–15 .…”

“… 8 , 9 In addition, serum CysC was shown to be a stronger predictor of the risk of cardiovascular and cerebrovascular events in older persons compared to sCr. 10 , 11 , 12 Serum CysC also showed an independent association with cerebral artery stenosis and mortality in patients with stroke or cardiovascular disease who did not have chronic kidney disease (CKD). 13 , 14 , 15 Thus, serum CysC may have other roles in addition to its use as a marker of kidney dysfunction in patients with HICH.…”

Lower Glomerular Filtration Rate After Mild Stroke Induces Cognitive Impairment by Causing Endothelial Dysfunction

“…In recent years, because creatinine (Cr) is affected by muscle quality, gender, race and diet factors, and particularly, mild and moderate declines in renal function are inaccurately displayed by GFR estimated by creatinine, cystatin C (CysC) has been considered as an alternative biomarker for GFR evaluation 6 .The secretion of CysC in serum was constant, and as a new biomarker of glomerular function, it has attracted more and more attention 7 .Previous studies have reported that even mild renal function damage may have a poor prognosis for patients with AIS 8 . Meanwhile, lots of studies have reported that the level of serum CysC increased signi cantly after stroke 9,10 . However, few scholars associate the elevated level of serum CysC with early renal dysfunction.…”