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Cystatin C is a cysteine proteinase inhibitor which plays a role in vascular pathophysiology by down-regulating cathepsins K and S, which are overexpressed in aneurysmal and atherosclerotic lesions. It is strongly associated with subclinical atherosclerosis, cardiovascular mortality and major adverse cardiac events. The aim of our study is to investigate the role of Cystatin C to predict incident coronary heart disease (CHD) and stroke in the African American population.
Cystatin C was measured in 4322 participants with no prior history of CHD or stoke. The primary outcome was a composite of incident CHD and stroke. Incident CHD included myocardial infarction, fatal CHD, and cardiac procedure. Incident stroke included definite and probable cases, as well as out-of-hospital deaths with a stroke code. Cox regression was used to estimate hazard ratios (HRs) for incident events, adjusting for age, sex, smoking status, education level, HDL-cholesterol, LDL-cholesterol, total cholesterol, HbA1c, high-sensitivity CRP, estimated glomerular filtration rate (eGFR), body mass index (BMI), waist circumference, systolic blood pressure, physical activity, use of antihypertensive medication, statin use, diabetes status.
Over a median duration of follow up of 7.2 years, there were 148 incident CHD events and 103 incident stroke events. HR for composite outcome was 1.11 (95% CI 1.07 – 1.14) in the unadjusted model. This risk was reduced after adjusting for demographic and clinical factors (HR 1.09, 95%CI: 1.03 - 1.12), and eGFR (HR 1.08, 95% CI: 1.02 -1.16). When considered separately, the results for CHD and Stroke paralleled those for the composite outcome. Sex-stratified analysis showed the association to be stronger in men (HR 1.85, 95% CI: 1.20 – 2.85) than in women (HR 1.08, 95% CI: 0.98 – 1.20), and absent in women after full adjustment.
African American men with higher baseline Cystatin C levels are at increased risk of developing CHD and stroke when compared to women.
CORONARY: Acute Myocardial Infarction