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

  1. David M. Maahs1,
  2. Lorraine G. Ogden2,
  3. Adam Kretowski1,
  4. Janet K. Snell-Bergeon1,
  5. Gregory L. Kinney1,
  6. Tomas Berl3 and
  7. Marian Rewers1,2
  1. 1Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Aurora, Colorado
  2. 2Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
  3. 3Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado
  1. 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

Abstract

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.

Footnotes

  • Published ahead of print at http://diabetes.diabetesjournals.org on 27 August 2007. DOI: 10.2337/db07-0539.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received April 19, 2007.
    • Accepted July 23, 2007.
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  1. Diabetes vol. 56 no. 11 2774-2779
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