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Multicenter Study
. 2010 Mar;3(2):159-64.
doi: 10.1161/CIRCOUTCOMES.109.875369. Epub 2010 Jan 19.

Cystatin C and sudden cardiac death risk in the elderly

Rajat Deo  1 , Nona Sotoodehnia, Ronit Katz, Mark J Sarnak, Linda F Fried, Michel Chonchol, Bryan Kestenbaum, Bruce M Psaty, David S Siscovick, Michael G Shlipak
Affiliations
Multicenter Study

Cystatin C and sudden cardiac death risk in the elderly

Rajat Deo et al. Circ Cardiovasc Qual Outcomes. 2010 Mar.

Abstract

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.

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Figures

Figure 1
Figure 1. Sudden cardiac death rate per year
x-axis: cystatin C and creatinine-based estimated GFR tertiles y-axis: sudden cardiac death rates per year (% per year)
See this image and copyright information in PMC

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