03555nas a2200445 4500008004100000022001400041245008100055210006900136260001600205300001200221490000800233520234700241653000902588653001502597653001502612653001502627653001402642653001102656653002202667653003102689653001802720653001102738653001402749653001102763653002602774653000902800653001702809653001802826100002002844700001602864700003202880700002002912700002502932700002002957700002002977700002102997700002403018710003203042856003503074 2005 eng d a1539-370400aCystatin C concentration as a risk factor for heart failure in older adults.0 aCystatin C concentration as a risk factor for heart failure in o c2005 Apr 05 a497-5050 v1423 a

BACKGROUND: Previous studies that evaluated the association of kidney function with incident heart failure may be limited by the insensitivity of serum creatinine concentration for detecting abnormal kidney function.

OBJECTIVE: To compare serum concentrations of cystatin C (a novel marker of kidney function) and creatinine as predictors of incident heart failure.

DESIGN: Observational study based on measurement of serum cystatin C from frozen sera obtained at the 1992-1993 visit of the Cardiovascular Health Study. Follow-up occurred every 6 months.

SETTING: Adults 65 years of age or older from 4 communities in the United States.

PARTICIPANTS: 4384 persons without previous heart failure who had measurements of serum cystatin C and serum creatinine.

MEASUREMENTS: Incident heart failure.

RESULTS: The mean (+/-SD) serum concentrations of cystatin C and creatinine were 82 +/- 25 nmol/L (1.10 +/- 0.33 mg/L) and 89 +/- 34 micromol/L (1.01 +/- 0.39 mg/dL), respectively. During a median follow-up of 8.3 years (maximum, 9.1 years), 763 (17%) participants developed heart failure. After adjustment for demographic factors, traditional and novel cardiovascular risk factors, cardiovascular disease status, and medication use, sequential quintiles of cystatin C concentration were associated with a stepwise increased risk for heart failure in Cox proportional hazards models (hazard ratios, 1.0 [reference], 1.30 [95% CI, 0.96 to 1.75], 1.44 [CI, 1.07 to 1.94], 1.58 [CI, 1.18 to 2.12], and 2.16 [CI, 1.61 to 2.91]). In contrast, quintiles of serum creatinine concentration were not associated with risk for heart failure in adjusted analysis (hazard ratios, 1.0 [reference], 0.77 [CI, 0.59 to 1.01], 0.85 [CI, 0.64 to 1.13], 0.97 [CI, 0.72 to 1.29], and 1.14 [CI, 0.87 to 1.49]).

LIMITATIONS: The mechanism by which cystatin C concentration predicts risk for heart failure remains unclear.

CONCLUSIONS: The cystatin C concentration is an independent risk factor for heart failure in older adults and appears to provide a better measure of risk assessment than the serum creatinine concentration. *For a full list of participating Cardiovascular Health Study investigators and institutions, see http://www.chs-nhlbi.org.

10aAged10aBiomarkers10aCreatinine10aCystatin C10aCystatins10aFemale10aFollow-Up Studies10aGlomerular Filtration Rate10aHeart Failure10aHumans10aIncidence10aKidney10aKidney Function Tests10aMale10aRisk Factors10aUnited States1 aSarnak, Mark, J1 aKatz, Ronit1 aStehman-Breen, Catherine, O1 aFried, Linda, F1 aJenny, Nancy, Swords1 aPsaty, Bruce, M1 aNewman, Anne, B1 aSiscovick, David1 aShlipak, Michael, G1 aCardiovascular Health Study uhttps://chs-nhlbi.org/node/827