Reduced Kidney Function Estimated by Cystatin C and Clinical Outcomes in Hypertensive Patients with Coronary Artery Disease: Association with Homocysteine and Other Cardiovascular Risk Factors

Abstract

Aims: To evaluate the association between serum cystatin C and homocysteine concentrations, cardiovascular risk factors and cardiovascular events in hypertensive patients with coronary artery disease (CAD). Methods: 260 patients with hypertension and CAD (mean age 56.9 ± 9.3) were included. During a mean 40-month follow-up the combined end-point of death from all causes, non-fatal myocardial infarction and stroke or coronary revascularization was assessed. Results: Subjects in the highest serum cystatin C quartile (>103.4 nmol/l) as compared with the lowest were older, were characterized by a higher frequency of multivessel CAD, higher levels of homocysteine (13.2 ± 5.2 vs. 11.4 ± 4.2 µmol/l; p < 0.01), fibrinogen and high-sensitivity C-reactive protein and by an increased intima-media thickness. Combined end-point occurred twice as frequently in the 4th quartile of serum cystatin C as compared with the 1st quartile (10.8 vs. 20.3%; p = 0.11). In an univariate analysis, but not in a multivariate model, cystatin C concentration predicted the combined end-point (Exp(B) = 1.096; p < 0.05). Conclusion: In hypertensive patients with CAD, serum cystatin C level was independently associated with the extent of CAD, homocysteine plasma level and traditional vascular risk factors. However, serum cystatin C concentration did not independently predict the combined end-point.

Independent associations of urinary albumin-to-creatinine ratio and serum cystatin C with carotid intima-media thickness in community-living Taiwanese adults

“…Increased cystatin C levels are associated with carotid IMT in a multi-ethnic study on atherosclerosis [ 24 ], in the general population [ 23 ], in the health check-up population [ 20 ], in postmenopausal women [ 21 ], in metabolic syndrome patients [ 19 ], in patients with hypertension [ 16 , 17 , 25 ], and in patients with type 2 diabetes [ 26 , 41 ]. By contrast, a study investigated 446 Japanese adults without chronic kidney disease and proteinuria and did not find the relationship of cystatin C and carotid IMT [ 22 ].…”

Maternal diet: a modulator for epigenomic regulation during development in nonhuman primates and humans

“…46 Diabetes and diet have also been shown to alter the gut microbiome, but there has been no causal relationship described between altered microbiome and risk of obesity and diabetes owing to confounding human factors. 47 The importance of symbiotic microbial community is undeniable.…”

Diagnostic and prognostic value of cystatin C as an early marker of renal dysfunction in patients with cardiovascular pathology

“…In addition, in hypertensive patients with coronary heart disease, Cys C is associated with severity of coronary artery disease, homocysteine levels in plasma and traditional risk factors. It was also found that Cys C serves not only a marker of renal dysfunction but also a marker of chronic inflammation in patients with hypertension [17,18,37,38].…”

“…Cys C is freely filtered in glomerular capillaries, and since its molecule is not exposed to either tubular reabsorption or secretion, it can be considered almost a perfect marker of gFr. The concentration of Cys C in serum should be inversely related to the size of the gFr since when it enters the tubular space during reabsorption, Cys C is almost completely metabolized in the proximal convulsive tubule [14,18,20].…”