BACKGROUND: Persons with early kidney disease have an increased risk of cardiovascular events and mortality, but the importance of accelerated atherosclerosis in promoting these outcomes is unclear. We therefore explored whether serum cystatin C level is associated with carotid intima-media thickness (IMT) in ambulatory adults without clinical heart disease. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: We evaluated 6,557 ethnically diverse persons free of clinical cardiovascular disease aged 45 to 84 years at the baseline visit of the Multi-Ethnic Study of Atherosclerosis. PREDICTORS: Kidney function was estimated by using 2 methods: serum cystatin C level and estimated glomerular filtration rate, based on creatinine and cystatin C levels. OUTCOMES & MEASUREMENTS: Study outcomes were internal and common carotid IMT, measured by using high-resolution B-mode ultrasound. Multivariate linear and logistic regressions were used to evaluate the independent association of kidney function with carotid IMT. RESULTS: In unadjusted linear analysis, each SD (0.23 mg/L) greater cystatin C level was associated with 0.091-mm greater internal carotid IMT (P < 0.001), but this association was diminished by 70% after adjustment for age, sex, and race/ethnicity (0.027 mm; P < 0.001) and was no longer significant after adjustment for cardiovascular risk factors (0.005 mm; P = 0.5). Similarly, the strong unadjusted associations of cystatin C level with common carotid IMT disappeared after adjustment. Chronic kidney disease, defined by using either creatinine level or cystatin C-based estimated glomerular filtration rate less than 60 mL/min/1.73 m(2), had no independent association with internal and common carotid IMT. LIMITATIONS: There were few participants with severe kidney disease. CONCLUSIONS: Cystatin C level had no independent association with carotid IMT in a population free of clinical heart disease. This observation suggests that accelerated atherosclerosis is unlikely to be the primary mechanism explaining the independent association of cystatin C level with cardiovascular risk.
BACKGROUND:Persons with early kidney disease have an increased risk of cardiovascular events and mortality, but the importance of accelerated atherosclerosis in promoting these outcomes is unclear. We therefore explored whether serum cystatin C level is associated with carotid intima-media thickness (IMT) in ambulatory adults without clinical heart disease. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: We evaluated 6,557 ethnically diverse persons free of clinical cardiovascular disease aged 45 to 84 years at the baseline visit of the Multi-Ethnic Study of Atherosclerosis. PREDICTORS: Kidney function was estimated by using 2 methods: serum cystatin C level and estimated glomerular filtration rate, based on creatinine and cystatin C levels. OUTCOMES & MEASUREMENTS: Study outcomes were internal and common carotid IMT, measured by using high-resolution B-mode ultrasound. Multivariate linear and logistic regressions were used to evaluate the independent association of kidney function with carotid IMT. RESULTS: In unadjusted linear analysis, each SD (0.23 mg/L) greater cystatin C level was associated with 0.091-mm greater internal carotid IMT (P < 0.001), but this association was diminished by 70% after adjustment for age, sex, and race/ethnicity (0.027 mm; P < 0.001) and was no longer significant after adjustment for cardiovascular risk factors (0.005 mm; P = 0.5). Similarly, the strong unadjusted associations of cystatin C level with common carotid IMT disappeared after adjustment. Chronic kidney disease, defined by using either creatinine level or cystatin C-based estimated glomerular filtration rate less than 60 mL/min/1.73 m(2), had no independent association with internal and common carotid IMT. LIMITATIONS: There were few participants with severe kidney disease. CONCLUSIONS:Cystatin C level had no independent association with carotid IMT in a population free of clinical heart disease. This observation suggests that accelerated atherosclerosis is unlikely to be the primary mechanism explaining the independent association of cystatin C level with cardiovascular risk.
Authors: Nicolas Rodondi; Patrick Yerly; Anne Gabriel; Walter F Riesen; Michel Burnier; Fred Paccaud; Pascal Bovet Journal: Nephrol Dial Transplant Date: 2007-01-05 Impact factor: 5.992
Authors: David Singh; Mary A Whooley; Joachim H Ix; Sadia Ali; Michael G Shlipak Journal: Nephrol Dial Transplant Date: 2007-01-08 Impact factor: 5.992
Authors: C R Keller; M C Odden; L F Fried; A B Newman; S Angleman; C A Green; S R Cummings; T B Harris; M G Shlipak Journal: Kidney Int Date: 2006-12-20 Impact factor: 10.612
Authors: Michael G Shlipak; Ronit Katz; Mark J Sarnak; Linda F Fried; Anne B Newman; Catherine Stehman-Breen; Stephen L Seliger; Brian Kestenbaum; Bruce Psaty; Russell P Tracy; David S Siscovick Journal: Ann Intern Med Date: 2006-08-15 Impact factor: 25.391
Authors: Lesley A Stevens; Josef Coresh; Christopher H Schmid; Harold I Feldman; Marc Froissart; John Kusek; Jerome Rossert; Frederick Van Lente; Robert D Bruce; Yaping Lucy Zhang; Tom Greene; Andrew S Levey Journal: Am J Kidney Dis Date: 2008-03 Impact factor: 8.860
Authors: Joachim H Ix; Michael G Shlipak; Ronit Katz; Matthew J Budoff; David M Shavelle; Jeffrey L Probstfield; Junichiro Takasu; Robert Detrano; Kevin D O'Brien Journal: Am J Kidney Dis Date: 2007-09 Impact factor: 8.860
Authors: Ying L Liu; Moyses Szklo; Karina W Davidson; Joan M Bathon; Jon T Giles Journal: Arthritis Care Res (Hoboken) Date: 2015-10 Impact factor: 4.794
Authors: Ron T Gansevoort; Kunihiro Matsushita; Marije van der Velde; Brad C Astor; Mark Woodward; Andrew S Levey; Paul E de Jong; Josef Coresh Journal: Kidney Int Date: 2011-02-02 Impact factor: 10.612
Authors: Michael G Shlipak; Kunihiro Matsushita; Johan Ärnlöv; Lesley A Inker; Ronit Katz; Kevan R Polkinghorne; Dietrich Rothenbacher; Mark J Sarnak; Brad C Astor; Josef Coresh; Andrew S Levey; Ron T Gansevoort Journal: N Engl J Med Date: 2013-09-05 Impact factor: 91.245
Authors: Kihei Yoneyama; Ola Gjesdal; Eui-Young Choi; Colin O Wu; W Gregory Hundley; Antoinette S Gomes; Chia-Ying Liu; Robyn L McClelland; David A Bluemke; Joao A C Lima Journal: Circulation Date: 2012-11-12 Impact factor: 29.690
Authors: Hu Li; Allison Kuipers; Candace M Kammerer; Clareanne H Bunker; Lewis H Kuller; Iva Miljkovic; Alan L Patrick; Victor W Wheeler; Joseph M Zmuda Journal: Ethn Dis Date: 2013 Impact factor: 1.847
Authors: Vasantha Jotwani; Rebecca Scherzer; Andy Choi; Lynda Szczech; Joseph F Polak; Richard A Kronmal; Carl Grunfeld; Michael Shlipak Journal: Am J Nephrol Date: 2011-04-21 Impact factor: 3.754
Authors: Anjali Ganda; Martin Magnusson; Laurent Yvan-Charvet; Bo Hedblad; Gunnar Engström; Ding Ai; Thomas J Wang; Robert E Gerszten; Olle Melander; Alan R Tall Journal: Circulation Date: 2013-02-01 Impact factor: 29.690
Authors: Bakhtawar K Mahmoodi; Hiroshi Yatsuya; Kunihiro Matsushita; Yinying Sang; Rebecca F Gottesman; Brad C Astor; Mark Woodward; W T Longstreth; Bruce M Psaty; Michael G Shlipak; Aaron R Folsom; Ron T Gansevoort; Josef Coresh Journal: Stroke Date: 2014-05-29 Impact factor: 7.914