- Serum Cystatin C, but not urine-based renal biomarkers, predicts cardiovascular (CV) disease (CVD) risk in people with type 2 diabetes (T2D) following acute coronary syndrome (ACS).
Why this matters
- Mechanisms underlying the link between chronic kidney disease and cardiovascular disease are unclear.
- Evaluation of prognostic performance of serum Cystatin C and urine renal biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1 protein, and urinary protein excretion indices) in 5380 patients with T2D and recent ACS in EXAMINE.
- Primary endpoint was composite nonfatal myocardial infarction, nonfatal stroke, or CV death.
- Funding: Takeda.
- During 18-month median follow-up, primary endpoint, death, and heart failure hospitalization occurred in 11.5%, 6.1%, and 3.0%, respectively.
- After adjustments including for baseline estimated glomerular filtration rate, all biomarkers were strongly associated with all endpoints.
- However, with all 5 renal biomarkers tested simultaneously in a multimarker integrative model, only Cystatin C (per 1 standard deviation) was associated with the primary endpoint (adjusted HR, 1.28; P≤.001) and all-cause mortality (adjusted HR, 1.51; P≤.001).
- After full adjustment, Cystatin C remained the only renal biomarker associated with clinical events.
- Findings limited to EXAMINE criteria.
- Missing protein excretion data.
- Possible residual confounding.
- No accounting for time-updated covariates.