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Cystatin C and risk of vascular and nonvascular mortality: a prospective cohort study of older men
Author(s) -
Emberson J. R.,
Haynes R.,
Dasgupta T.,
Mafham M.,
Landray M. J.,
Baigent C.,
Clarke R.
Publication year - 2010
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.2010.02214.x
Subject(s) - medicine , cystatin c , prospective cohort study , confounding , cohort , proportional hazards model , cohort study , epidemiology , blood pressure , vascular disease , demography , renal function , sociology
. Emberson JR, Haynes R, Dasgupta T, Mafham M, Landray MJ, Baigent C, Clarke R (University of Oxford, Oxford, UK). Cystatin C and risk of vascular and nonvascular mortality: a prospective cohort study of older men. J Intern Med 2010; 268 : 145–154. Objective. To assess the relevance of cystatin C, as a marker of mild‐to‐moderate renal impairment, for vascular and nonvascular mortality in older people. Design. Prospective cohort study. Setting. Re‐survey in 1997 to 1998 of survivors in the 1970 Whitehall study of London civil servants. Subjects. Five thousand three hundred and seventy‐one men (mean age at resurvey: 77 years) who took part in the resurvey and had plasma cystatin C concentration measured. Main outcome measures. Cause‐specific mortality over subsequent 11 years (1997 to 2008). Methods. Cox regression was used to estimate the associations of cystatin C with vascular and nonvascular mortality, before and after adjustment for prior disease and other risk factors (including lifetime blood pressure). Results. During an 11.0‐year follow‐up period, there were 1171 deaths from vascular causes [26 per 1000 per year (py)] and 1615 deaths from nonvascular causes (36 per 1000 py). Compared with men with cystatin C in the bottom fifth of the distribution, men in the top 10th had about two‐fold higher mortality rates from vascular and nonvascular mortality (fully adjusted P both <0.001) even after adjustment for prior disease and all measured confounders, including lifetime blood pressure. The fully adjusted relative risks per 50% higher cystatin C concentrations were 1.66 [95% CI 1.48 to 1.85] for vascular mortality, 1.92 [95% CI 1.66 to 2.22] for ischaemic heart disease mortality and 1.46 [95% CI 1.31 to 1.61] for nonvascular mortality. Conclusions. In older men, plasma concentration of cystatin C, probably as a marker of mild renal disease, is a strong independent predictor of both vascular and nonvascular mortality.