Author + information
- Received July 26, 2004
- Revision received September 14, 2004
- Accepted September 28, 2004
- Published online January 18, 2005.
- Michael G. Shlipak, MD, MPH*,* (, )
- Mark J. Sarnak, MD†,
- Ronit Katz, PhD‡,
- Linda Fried, MD, MPH§,
- Stephen Seliger, MD∥,
- Anne Newman, MD, MPH¶,
- David Siscovick, MD, MPH# and
- Catherine Stehman-Breen, MD, MS**
- ↵*Reprint requests and correspondence:
Dr. Michael G. Shlipak, General Internal Medicine Section (111A-1), Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, California 94121
Objectives We sought to evaluate cystatin-C, a novel measure of renal function, as a predictor of mortality in elderly persons with heart failure (HF) and to compare it with creatinine.
Background Renal function is an important prognostic factor in patients with HF, but creatinine levels, which partly reflect muscle mass, may be insensitive for detecting renal insufficiency.
Methods A total of 279 Cardiovascular Health Study participants with prevalent HF and measures of serum cystatin-C and creatinine were followed for mortality outcomes over a median of 6.5 years.
Results Median creatinine and cystatin-C levels were 1.05 mg/dl and 1.26 mg/l. Each standard deviation increase in cystatin-C (0.35 mg/l) was associated with a 31% greater adjusted mortality risk (95% confidence interval [CI] 20% to 43%, p < 0.001), whereas each standard deviation increase in creatinine (0.39 mg/dl) was associated with a 17% greater adjusted mortality risk (95% CI 1% to 36%, p = 0.04). When both measures were combined in a single adjusted model, cystatin-C remained associated with elevated mortality risk (hazard ratio 1.60, 95% CI 1.32 to 1.94), whereas creatinine levels appeared associated with lower risk (hazard ratio 0.73, 95% CI 0.57 to 0.95).
Conclusions Cystatin-C is a stronger predictor of mortality than creatinine in elderly persons with HF. If confirmed in future studies, this new marker of renal function could improve risk stratification in patients with HF.
Dr. Shlipak is supported by the National Heart, Lung and Blood Institute (NHLBI) Grant R01 HL073208 (National Institutes of Health [NIH], Bethesda, Maryland), RWJF Generalist Physician Faculty Scholars Award, and AFAR Paul Beeson Physician Faculty Scholars Award. The Cardiovascular Health Study (CHS) is supported by contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, and N01 HC-15103 from the NHLBI of the NIH. A full list of participating CHS investigators and institutions can be found at http://www.chs-nhlbi.org.
- Received July 26, 2004.
- Revision received September 14, 2004.
- Accepted September 28, 2004.
- American College of Cardiology Foundation