Comparison of Cystatin C and Creatinine as Predictors of Cardiovascular Events in a Community-Based Elderly Population

BACKGROUND: Reduced renal function is an established risk factor for cardiovascular events. We compared 3 measures of renal function-serum cystatin C, serum creatinine, and calculated creatinine clearance-as predictors of subsequent cardiovascular events in a community-based population of elderly individuals. METHODS: Comprehensive cardiovascular risk factor data were available for 1410 surviving participants of previous Busselton health surveys who were >= 60 years old. Hazard ratios for risk of incident coronary heart disease and cardiovascular disease over 10 years of follow-up were derived for each baseline measure of renal function by use of Cox regression. RESULTS: All measures of renal function were significantly related to risks of morbidity and mortality from coronary heart disease and cardiovascular disease. There were 453 incident cardiovascular disease events; and the age-and sex-adjusted hazard ratios (95% CIs) were 1.34 (1.23-1.46), 1.32 (1.20-1.45), and 1.22 (1.06-1.41) per 1-SD deterioration in cystatin C, creatinine, and creatinine clearance, respectively. All 3 measures gave approximately the same age-adjusted relative risk estimates. After further adjustment for established cardiovascular risk factors, the relative risk estimates were all reduced but remained statistically significant (P < 0.05). Cystatin C was not a significant predictor for cardiovascular disease after adjustment for creatinine clearance. CONCLUSIONS: In relation to predicting risk for coronary heart disease or cardiovascular disease over a 10 year follow-up in a community-based population of elderly subjects, there was no evidence that cystatin C was a better risk predictor than creatinine or creatinine clearance. (C) 2010 American Association for Clinical Chemistry