Cystatin C and risk of vascular and nonvascular mortality: a prospective cohort study of older men
Version of Record online: 20 JAN 2010
© 2010 Blackwell Publishing Ltd
Journal of Internal Medicine
Volume 268, Issue 2, pages 145–154, August 2010
How to Cite
Emberson, J. R., Haynes, R., Dasgupta, T., Mafham, M., Landray, M. J., Baigent, C. and Clarke, R. (2010), Cystatin C and risk of vascular and nonvascular mortality: a prospective cohort study of older men. Journal of Internal Medicine, 268: 145–154. doi: 10.1111/j.1365-2796.2010.02214.x
- Issue online: 1 JUL 2010
- Version of Record online: 20 JAN 2010
- risk factors
Abstract. 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.