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Arpegård J, Magnusson PKE, Chen X, Ridefelt P, Pedersen NL, De Faire U, Svensson P. Cystatin C Predicts Incident Cardiovascular Disease in Twins. J Am Heart Assoc 2016; 5:e003085. [PMID: 27353608 PMCID: PMC4937258 DOI: 10.1161/jaha.115.003085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/13/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cystatin C is associated with both renal function and atherosclerotic cardiovascular disease (ASCVD). We have previously shown a genetic correlation between cystatin C and prevalent ASCVD. The objective of this article is to study whether variation in cystatin C or creatinine predicts incident ASCVD when controlled for genetic factors. METHODS AND RESULTS The predictive value of cystatin C and creatinine for incident ASCVD was studied in 11 402 Swedish twins, free of CVD at baseline, in an adjusted Cox-regression model during a median follow-up of 71 months. Twin pairs discordant for incident stroke, myocardial infarction and ASCVD during follow-up were identified and within-pair comparisons regarding cystatin C and creatinine levels were performed. We also investigated whether contact frequency and degree of shared environment influences were associated with similarity in cystatin C levels. In univariate analysis, cystatin C predicted incident ASCVD hazard ratio 1.57, 95% CI 1.47-1.67. When adjusted for traditional Framingham risk factors as covariates, cystatin C remained a predictor of incident stroke hazard ratio 1.45, 95% CI (1.25-1.70), ASCVD hazard ratio 1.26, 95% CI (1.13-1.41), and myocardial infarction hazard ratio 1.16, 95% CI (1.01-1.33). In twins discordant for incident stroke, cystatin C at baseline was higher in the twin who experienced a stroke compared to the healthy co-twin (1.11±0.3 mg/L versus 1.06±0.3 mg/L), whereas creatinine was lower in the twin who developed CVD compared to their healthy co-twins (76.1±16.9 μmol/L versus 79.4±20.3 μmol/L). CONCLUSIONS Variation in cystatin C relates to incident ASCVD and to stroke when adjusted for genetic confounding. In identical twins, cystatin C may be a sensitive marker of early hypertensive end-organ damage and small-vessel disease, whereas creatinine level may reflect nutritional status. The findings in disease-discordant monozygotic twins indicate that unique, possibly preventable, environmental factors are important.
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Affiliation(s)
- Johannes Arpegård
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Xu Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Ridefelt
- Division of Clinical Chemistry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ulf De Faire
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Svensson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
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Kammerer T, Klug F, Schwarz M, Hilferink S, Zwissler B, von Dossow V, Karl A, Müller HH, Rehm M. Comparison of 6% hydroxyethyl starch and 5% albumin for volume replacement therapy in patients undergoing cystectomy (CHART): study protocol for a randomized controlled trial. Trials 2015; 16:384. [PMID: 26314293 PMCID: PMC4552376 DOI: 10.1186/s13063-015-0866-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 07/15/2015] [Indexed: 12/28/2022] Open
Abstract
Background The use of artificial colloids is currently controversial, especially in Central Europe Several studies demonstrated a worse outcome in intensive care unit patients with the use of hydroxyethyl starch. This recently even led to a drug warning about use of hydroxyethyl starch products in patients admitted to the intensive care unit. The data on hydroxyethyl starch in non–critically ill patients are insufficient to support perioperative use. Methods/Design We are conducting a single-center, open-label, randomized, comparative trial with two parallel patient groups to compare human albumin 5 % (test drug) with hydroxyethyl starch 6 % 130/0.4 (comparator). The primary endpoint is cystatin C ratio, calculated as the ratio of the cystatin value at day 90 after surgery relative to the preoperative value. Secondary objectives are inter alia the evaluation of the influence of human albumin and hydroxyethyl starch on further laboratory chemical and clinical parameters, glycocalyx shedding, intensive care unit and hospital stay and acute kidney injury as defined by RIFLE criteria (risk of renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage kidney disease) criteria. Discussion There is a general lack of evidence on the relative safety and effects of hydroxyethyl starch compared with human albumin for volume replacement in a perioperative setting. Previously conducted studies of surgical patients in which researchers have compared different hydroxyethyl starch products included too few patients to properly evaluate clinical important outcomes such as renal function. In the present study in a high-risk patient population undergoing a major surgical intervention, we will determine if perioperative fluid replacement with human albumin 5 % will have a long-term advantage over a third-generation hydroxyethyl starch 130/0.4 on the progression of renal dysfunction until 90 days after surgery. Trial registration EudraCT number 2010-018343-34. Registered on 11 January 2010.
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Affiliation(s)
- Tobias Kammerer
- Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Florian Klug
- Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Michaela Schwarz
- Department of Anesthesiology, Surgical Clinic Munich-Bogenhausen, Denninger Strasse 44, 81679, Munich, Germany.
| | - Sebastian Hilferink
- Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Bernhard Zwissler
- Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Vera von Dossow
- Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Alexander Karl
- Department of Urology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Hans-Helge Müller
- Institute of Medical Biometry and Epidemiology, Philipps University, Bunsenstrasse 3, 35037, Marburg, Germany.
| | - Markus Rehm
- Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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