Cystatin C identifies cardiovascular risk better than creatinine-based estimates of glomerular filtration in middle-aged individuals without a history of cardiovascular disease

• Autores: Per-Arne Svensson, M. Andersson, P. Almgren, B. Hedblad, Gabriella A. Engstrom, M. Persson, A. Christensson, O. Melander
• Localización: Journal of Internal Medicine, ISSN-e 1365-2796, Vol. 275, Nº. 5, 2014, págs. 506-521
• Idioma: inglés
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• Resumen

  • Objectives Creatinine- and cystatin C-based estimates of renal function are considered to be cardiovascular disease (CVD) risk factors, but the clinical utility in middle-aged subjects without a history of CVD is controversial.

    Design We related plasma cystatin C and creatinine-based glomerular filtration rate (GFR) [MDRD, CKD-EPI-2009, and CKD-EPI-comb (a combination of creatinine and cystatin C)] to incident CVD, CVD mortality, all-cause mortality, and heart failure in 4650 middle-aged subjects without CVD.

    Results The hazard ratio (HR) per standard deviation increment (95% CI) of cystatin C predicted incident CVD (1.22, 1.11–1.33; P < 0.0001), CVD mortality (1.44, 1.24–1.66; P < 0.0001), all-cause mortality (1.15, 1.05–1.26; P = 0.002), and heart failure (1.27, 1.05–1.55; P = 0.02), whereas MDRD and CKD-EPI-2009 only predicted CVD mortality (0.79, 0.66–0.93; P = 0.006 and 0.78, 0.66–0.92; P = 0.003, respectively). Cystatin C led to a significant increase in the net reclassification improvement for all endpoints, except heart failure. Only within the quartile with the worst renal function were all measures related to all-cause and CVD mortality. The top 25% of cystatin C in the population significantly predicted risk of incident CVD and CVD mortality, whereas MDRD and CKD-EPI-2009 were predictors of CVD mortality only at a GFR < 60 mL/min/1.73 m2 (11–13% of the population) and of incident CVD only at a GFR < 45 mL/min/1.73 m2 (<1% of the population).

    Conclusion Cystatin C is a better risk marker for CVD morbidity and mortality than creatinine-based GFR. Whether this is explained by cystatin C being a better marker for true GFR or through other effects of cystatin C remains to be shown.