半胱氨酸蛋白酶抑制剂C浓度升高是老年人心衰的危险因素

作     者：Sarnak M. J. Katz R. Stehman-Breen C. O. M.G. Shlipak 韩瑞娟 

作者机构：Veterans Affairs Medical Center 4150 Clement Street San Francisco CA 94121 United States Dr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第11期

页      面：18-18页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：老年人心衰 心血管健康 冷冻血 观察性研究 肾功能 心血管疾病 参考值 肌酸酐 年所 人口统计学 

摘      要：Background: Previous studies that evaluated the association of kidney function with incident heart failure may be limited by the insensitivity of serum creatinine concentration for detecting abnormal kidney function. Objective: To compare serum concentrations of cystatin C(a novel marker of kidney function) and creatinine as predictors of incident heart failure. Design: Observational study based on measurement of serum cystatin C from frozen sera obtained at the 1992-1993 visit of the Cardiovascular Health Study. Follow-up occurred every 6 months. Setting: Adults 65 years of age or older from 4 communities in the United States. Participants: 4384 persons without previous heart failure who had measurements of serum cystatin C and serum creatinine. Measurements: Incident heart failure. Results: The mean(±SD) serum concentrations of cystatin C and creatinine were 82±25 nmol/L(1.10±0.33 mg/L) and 89±34 μmol/L(1.01±0.39 mg/dL), respectively. During a median follow-up of 8.3 years(maximum, 9.1 years), 763(17%) participants developed heart failure. After adjustment for demographic factors, traditional and novel cardiovascular risk factors, cardiovascular disease status, and medication use, sequential quintiles of cystatin C concentration were associated with a stepwise increased risk for heart failure in Cox proportional hazards models(hazard ratios, 1.0 reference , 1.30 95%CI, 0.96 to 1.75 , 1.44 CI, 1.07 to 1.94 , 1.58 CI, 1.18 to 2.12 , and 2.16 CI, 1.61 to 2.91 ). In contrast, quintiles of serum creatinine concentration were not associated with risk for heart failure in adjusted analysis(hazard ratios, 1.0 reference , 0.77 CI, 0.59 to 1.01 , 0.85 CI, 0.64 to 1.13 , 0.97 CI, 0.72 to 1.29 , and 1.14 CI, 0.87 to 1.49 ). Limitations: The mechanism by which cystatin C concentration predicts risk for heart failure remains unclear. Conclusions: The cystatin C concentration is an independent risk factor for heart failure in older adults and appears to provide a better measure