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Diabetes Publish Ahead of Print published online ahead of print July 27, 2007
DOI: 10.2337/db07-0539
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Original Research

Serum Cystatin C Predicts Progression of Subclinical Coronary Atherosclerosis in Persons with Type 1 Diabetes Mellitus

David M. Maahs, M.D.1, Lorraine G. Ogden, Ph.D.2, Adam Kretowski, M.D.1, Janet K. Snell-Bergeon, M.P.H.1, Gregory L. Kinney, M.P.H.1, Tomas Berl, M.D.3, and Marian Rewers, M.D., Ph.D.1,,2

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

Correspondence: David.Maahs{at}uchsc.edu

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 predictor of cardiovascular events and mortality. We hypothesized that in persons with type 1 diabetes mellitus cystatin C would: i) predict progression of subclinical coronary atherosclerosis (SCA), and ii) 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 [AER].

Research Design and Methods:Coronary artery calcification (CAC) 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 >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's Information Criterion (AIC) was used to compare the fit of the competing models.

Results:The stepwise model included cystatin C (OR=1.44, 95% CI: 1.00-2.18, p=0.048), age, baseline CAC, sex, diabetes duration, systolic blood pressure, and HDL. This model had a better fit than any of the competing models with serum creatinine, GFRCG, GFRMDRD, or AER replacing cystatin C.

Conclusions:In persons with type 1 diabetes, cystatin C modestly predicts SCA.


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Copyright © 2007 by the American Diabetes Association.