%0 Journal Article %J Circ Cardiovasc Qual Outcomes %D 2010 %T Cystatin C and sudden cardiac death risk in the elderly. %A Deo, Rajat %A Sotoodehnia, Nona %A Katz, Ronit %A Sarnak, Mark J %A Fried, Linda F %A Chonchol, Michel %A Kestenbaum, Bryan %A Psaty, Bruce M %A Siscovick, David S %A Shlipak, Michael G %K Age Factors %K Aged %K Biomarkers %K Chi-Square Distribution %K Creatinine %K Cystatin C %K Death, Sudden, Cardiac %K Female %K Glomerular Filtration Rate %K Humans %K Incidence %K Kidney Diseases %K Longitudinal Studies %K Male %K Proportional Hazards Models %K Risk Assessment %K Risk Factors %K Time Factors %K United States %K Up-Regulation %X

BACKGROUND: Recent studies have demonstrated an association between moderate kidney dysfunction and sudden cardiac death in people with cardiovascular disease.

METHODS AND RESULTS: The study was a longitudinal analysis among 4465 participants from the Cardiovascular Health Study without prevalent cardiovascular disease at baseline. Cystatin C and creatinine were measured from baseline sera. Sudden cardiac death (SCD) was defined as a sudden pulseless condition from a cardiac origin in a previously stable individual that occurred out of the hospital or in the emergency room. The association between cystatin C tertiles and SCD was determined with multivariate Cox proportional hazards. A similar analysis compared SCD incidence across creatinine-based estimated glomerular filtration rate (eGFR) tertiles. Over a median follow-up of 11.2 years, 91 adjudicated SCD events occurred. The annual incidence of SCD events increased across cystatin C tertiles: 10 events per 10 000 person years in tertile 1, 25 events per 10 000 person years in tertile 2, and 32 events per 10 000 person-years in the highest cystatin C tertile. These associations persisted after multivariate adjustment: hazards ratio=2.72; 95% confidence interval, 1.44 to 5.16 in tertile 2 and hazards ratio=2.67; 95% confidence interval, 1.33 to 5.35 in tertile 3. After multivariate adjustment, the rate of SCD also increased in a linear distribution across creatinine-based eGFR tertiles: 15 events per 10 000 person-years in tertile 1, 22 events per 10 000 person-years in tertile 2, and 27 events per 10 000 person-years in tertile 3. No significant associations, however, remained between creatinine-based eGFR and SCD after multivariable adjustment.

CONCLUSIONS: Impaired kidney function, as measured by cystatin C, has an independent association with SCD risk among elderly persons without clinical cardiovascular disease.

%B Circ Cardiovasc Qual Outcomes %V 3 %P 159-64 %8 2010 Mar %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20233980?dopt=Abstract %R 10.1161/CIRCOUTCOMES.109.875369