• Mark J Sarnak, Ronit Katz, Catherine O Stehman-Breen, Linda F Fried, Nancy Swords Jenny, Bruce M Psaty, Anne B Newman, David Siscovick, Michael G Shlipak, and Cardiovascular Health Study.
• Tufts-New England Medical Center, Boston, Massachusetts, USA.
• Ann. Intern. Med. 2005 Apr 5; 142 (7): 497505497-505.

BackgroundPrevious 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.ObjectiveTo compare serum concentrations of cystatin C (a novel marker of kidney function) and creatinine as predictors of incident heart failure.DesignObservational 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.SettingAdults 65 years of age or older from 4 communities in the United States.Participants4384 persons without previous heart failure who had measurements of serum cystatin C and serum creatinine.MeasurementsIncident heart failure.ResultsThe mean (+/-SD) serum concentrations of cystatin C and creatinine were 82 +/- 25 nmol/L (1.10 +/- 0.33 mg/L) and 89 +/- 34 micromol/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]).LimitationsThe mechanism by which cystatin C concentration predicts risk for heart failure remains unclear.ConclusionsThe cystatin C concentration is an independent risk factor for heart failure in older adults and appears to provide a better measure of risk assessment than the serum creatinine concentration. *For a full list of participating Cardiovascular Health Study investigators and institutions, see http://www.chs-nhlbi.org.

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