High levels of cystatin C predict the metabolic syndrome: the prospective Malmö Diet and Cancer Study


Correspondence: Martin Magnusson, Department of Cardiology, Skåne University Hospital, Inga-Marie Nilssons gata 46, floor 2, SE 205 02, Malmö, Sweden.

(fax: +46 40 33 62 09; e-mail: martin.magnusson@med.lu.se).



Cystatin C is a novel marker of cardiovascular disease (CVD); however, the underlying mechanisms remain unclear. Here, we prospectively investigated whether plasma levels of cystatin C predict new-onset metabolic syndrome (MetS) as well as long-term progression and incidence of the different components of the MetS.


Cystatin C was measured in 1502 individuals included in the Malmö Diet and Cancer cardiovascular cohort (mean age 56 years, 59% women) who were free from the MetS at baseline and subsequently underwent a follow-up examination after a median of 16 years. MetS was defined according to the NCEP-ATP-III guidelines. Logistic regression was used to adjust for covariates.

Main outcome measures

Metabolic syndrome and long-term progression as well as incidence of the different components of the MetS.


During follow-up, 428 subjects developed new-onset MetS. In age- and sex-adjusted analysis, compared with the lowest quartile of cystatin C, the odds ratios (95% confidence interval) for incident MetS in subjects with cystatin C levels in quartiles 2, 3 and 4 were 1.00 (0.71–1.40), 1.48 (1.06–2.07) and 1.91 (1.37–2.68), respectively (Ptrend < 0.001); this linear association remained significant even after full multivariate adjustment (Ptrend = 0.041). Interestingly, in this fully adjusted model, long-term progression of abdominal obesity was the only component of the MetS significantly associated with increasing quartiles of baseline cystatin C levels (Ptrend = 0.008).


These findings suggest that cystatin C may adversely affect metabolic factors, particularly abdominal obesity, thus contributing to development of the MetS. Our results may help to explain the link between cystatin C and development of CVD.