Cystatin C associates with arterial stiffness in older adults

Abstract

Large arteries commonly become stiff in kidney failure, but few studies have investigated arterial stiffness in earlier stages of kidney disease. We evaluated the association between kidney function and aortic pulse wave velocity (aPWV) and its potential modification by race, diabetes, or coronary heart disease in older adults. We measured aPWV in 2468 participants in the Health Aging and Body Composition (Health ABC) study; mean age was 73.7 yr, 40% were black, and 24% had diabetes. After categorizing kidney function into three groups on the basis of cystatin C level, multivariable analysis revealed that the medium and high cystatin C groups associated with a 5.3% (95% confidence interval 0.8 to 10.0%) and 8.0% (95% confidence interval 2.2 to 14.1%) higher aPWV than the low cystatin C group; however, chronic kidney disease, as defined by estimated GFR <60 ml/min per 1.73 m(2), did not significantly associate with aPWV. We did not identify interactions between cystatin C and race, diabetes, or coronary heart disease. In conclusion, stiffness of large arteries, a major risk factor for cardiovascular disease, may partially mediate the association between cystatin C and cardiovascular risk in older adults.

Figure 1.

(A and B) Unadjusted (A) and adjusted (B) geometric mean aPWV by cystatin C groups and CKD.

Figure 2.

(A) Adjusted spline of cystatin C with aPWV. (B) Adjusted spline of creatinine with aPWV. Adjusted for age, gender, race, site, body mass index, alcohol use (≤ 1 drink per day versus >1 drink per day), smoking, angiotensin-converting enzyme inhibitor use, angiotensin receptor blocker use, prevalent congestive heart failure, prevalent CHD, diabetes, ankle arm index, triglycerides, LDL cholesterol, HDL cholesterol, C-reactive protein, IL-6, heart rate, peripheral vascular disease, SBP, and DBP. Tick marks along the x axis indicate values for individual participants.