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Cystatin C Associates with Arterial Stiffness in Older Adults

Magdalena Madero^*, Christina L. Wassel^,,, Carmen A. Peralta, Samer S. Najjar^||, Kim Sutton-Tyrrell^¶, Linda Fried^**, Robert Canada, Anne Newman^¶, Michael G. Shlipak^,,,, Mark J. Sarnak for the Health ABC Study

^* Department of Nephrology, Instituto Nacional de Cardiología "Ignacio Chávez" México City, Mexico; Departments of Medicine, Epidemiology, and Biostatistics, University of California at San Francisco, and Section of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California; ^|| National Institute on Aging, National Institutes of Health, Bethesda, Maryland; ^¶ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, and ^** Renal-Electrolyte Division, University of Pittsburgh School of Medicine, and Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; University of Tennessee Health Science Center, Memphis, Tennessee; and Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts

Correspondence: Dr. Mark J. Sarnak, Box 391, Tufts Medical Center, 800 Washington Street, Boston, MA 02111. Phone: 617-636-1182; Fax: 617-636-8329; E-mail: msarnak{at}tuftsmedicalcenter.org

Received for publication March 24, 2008. Accepted for publication December 1, 2008.

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 m², 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.

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673