Association of cystatin C with ischemia in patients with coronary heart disease.
Association of cystatin C with ischemia in patients with coronary heart disease.
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DOI：
10.1002/clc.20465
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发表时间：
2009-11
影响因子：
2.7
通讯作者：
Whooley, Mary A
中科院分区：
文献类型：
--
作者：
Deo, Rajet;Shlipak, Michael G;Ix, Joachim H;Ali, Sadia;Schiller, Nelson B;Whooley, Mary A
胱抑素C浓度升高与心血管疾病发病率和死亡率升高相关。我们试图确定是否胱抑素C浓度升高与冠心病（CHD）患者的诱导性缺血相关。我们对899例门诊冠心病患者进行了一项横断面研究，测定了血清胱抑素C，并采用负荷超声心动图进行了运动平板试验。在241名半胱氨酸蛋白酶抑制剂C最高四分位数（>1.30 mg/L）的参与者中，38%有可诱导的缺血，而在半胱氨酸蛋白酶抑制剂C <0.92 mg/L的最低四分位数的参与者中，13%有可诱导的缺血;调整后的比值比[OR]：2.1; 95%置信区间[CI]：1.2至3.8; p = 0.01）。然而，这种关联在有和没有冠状动脉旁路移植术（CABG）史的参与者中存在差异，在β受体阻滞剂和他汀类药物的使用者和非使用者中也存在差异（相互作用的p值<0.1）。在无CABG病史的受试者中，胱抑素C水平最高四分位数的35%和最低四分位数的9%有诱导性缺血（校正OR：3.05; 95% CI：1.3-6.9; p = 0.008）。在未使用β受体阻滞剂的受试者中，胱抑素C水平最高四分位数的受试者中有44%和最低四分位数的受试者中有7%具有诱导性缺血（调整后OR：5.3; 95%CI：1.8-15.5; p = 0.002）。在未使用他汀类药物的参与者中，最高四分位数的39%参与者和最低四分位数的4%参与者有诱导性缺血（调整后OR：10.3; 95%CI：2.5-43.3; p = 0.001）。胱抑素C水平升高与门诊稳定型冠心病患者诱导性缺血独立相关
Elevated concentrations of cystatin C are associated with greater cardiovascular morbidity and mortality. We sought to determine whether elevated concentrations of cystatin C were associated with inducible ischemia in patients with coronary heart disease (CHD). We measured serum cystatin C and performed exercise treadmill testing with stress echocardiography in a cross-sectional study of 899 outpatients with CHD. Among the 241 participants in the highest quartile of cystatin C (>1.30 mg/L), 38% had inducible ischemia, compared with 13% of those in the lowest quartile of cystatin C <0.92 mg/L; adjusted odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.2 to 3.8; p = 0.01). However, this association differed in participants with and without a history of coronary artery bypass graft (CABG), as well as in users and nonusers of beta-blockers and statins (p values for interaction <0.1). Among participants without a history of CABG, 35% of those in the highest quartile and 9% of those in the lowest quartile of cystatin C had inducible ischemia (adjusted OR: 3.05; 95% CI: 1.3–6.9; p = 0.008). Among participants who were not using beta-blockers, 44% of those in the highest quartile and 7% in the lowest quartile of cystatin C had inducible ischemia (adjusted OR: 5.3; 95% CI: 1.8–15.5; p = 0.002). Among participants who were not using statins, 39% of participants in the highest quartile and 4% of those in the lowest quartile had inducible ischemia (adjusted OR: 10.3; 95% CI: 2.5–43.3; p = 0.001). Elevated levels of cystatin C are independently associated with inducible ischemia among outpatients with stable coronary disease.