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Serum Cystatin C Predicts Progression of Subclinical Coronary Atherosclerosis in Individuals With Type 1 Diabetes

¹ Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Aurora, Colorado
² Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
³ Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado

Address correspondence and reprint requests to David M. Maahs, MD, Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, P.O. Box 6511, Mail Stop A140, Aurora, CO 80045. E-mail: david.maahs{at}uchsc.edu

Abbreviations: AER, albumin excretion rate; AIC, Akaike information criterion; CAC, coronary artery calcification; CACTI, Coronary Artery Calcification in Type 1 Diabetes; CAD, coronary artery disease; CVD, cardiovascular disease; CVS, calcium volume score; GFR, glomerular filtration rate; GFRCG, GFR Cockcroft-Gault; GFRMDRD, GFR Modification of Diet in Renal Disease; SCA, subclinical coronary atherosclerosis

OBJECTIVE—Renal function is an important determinant of coronary atherosclerosis, and serum cystatin C is a novel accurate measure of glomerular filtration rate (GFR) and a predictor of cardiovascular events and mortality. We hypothesized that in individuals with type 1 diabetes, cystatin C would 1) predict progression of subclinical coronary atherosclerosis (SCA) and 2) be a stronger predictor of SCA than serum creatinine, GFR (estimated by the Cockcroft-Gault [GFRCG] and Modification of Diet in Renal Disease [GFRMDRD] formulas), and albumin excretion rate.

RESEARCH DESIGN AND METHODS—Coronary artery calcification was measured twice, using Imatron C-150 Ultrafast CT, over a 2.5 ± 0.4-year interval in 509 adults with type 1 diabetes (42% male, age 36 ± 9 years, duration 23 ± 9 years). SCA progression (n = 131) was defined as a >2.5 increase in square root calcium volume score or development of clinical coronary artery disease. Predictors of SCA progression were examined in a model selected by stepwise logistic regression and an a priori–determined model. Next, each measure of renal function was inserted into the stepwise model, one at a time, and Akaike information criterion was used to compare the fit of the competing models.

RESULTS—The stepwise model included cystatin C (odds ratio 1.44, 95% CI 1.00–2.18, P = 0.048), age, baseline coronary artery calcification, sex, diabetes duration, systolic blood pressure, and HDL. The stepwise model had a better fit than any of the competing models with serum creatinine, GFRCG, GFRMDRD, or albumin excretion rate replacing cystatin C.

CONCLUSIONS—In individuals with type 1 diabetes, cystatin C modestly predicts SCA.

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