Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2017; 9(2): 174-181
Published online Feb 26, 2017. doi: 10.4330/wjc.v9.i2.174
Association between high cystatin C levels and carotid atherosclerosis
Toshiyuki Kobayashi, Hirohide Yokokawa, Kazutoshi Fujibayashi, Tomomi Haniu, Teruhiko Hisaoka, Hiroshi Fukuda, Toshio Naito
Toshiyuki Kobayashi, Department of General Medicine, Zama General Hospital, Kanagawa 252-0011, Japan
Toshiyuki Kobayashi, Hirohide Yokokawa, Kazutoshi Fujibayashi, Tomomi Haniu, Teruhiko Hisaoka, Hiroshi Fukuda, Toshio Naito, Department of General Medicine, School of Medicine, Juntendo University, Tokyo 113-8431, Japan
Author contributions: Kobayashi T, Yokokawa H, Fujibayashi K, Haniu T, Hisaoka T, Fukuda H and Naito T participated in the design of the study; Kobayashi T, Yokokawa H and Fujibayashi K participated in data collection, analysis of the data, and drafting of the manuscript; Kobayashi T, Yokokawa H and Fujibayashi K conceived of the study, participated in its design, and revised the manuscript; Kobayashi T, Yokokawa H and Fujibayashi K participated in analysis of the data and revised the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Human Ethics Committee of Juntendo University.
Informed consent statement: The participants’ clinical data were retrospectively retrieved from an institutional database. All of the examinations included in this study were performed as a routine part of the program, and none were aimed at specifically collecting data for the current study. The study protocol was approved by the institutional ethics committee. So, we did not obtain informed consent from every participant.
Conflict-of-interest statement: None of the authors of this paper has a financial or personal relationship with other people or organizations that could inappropriate influence or bias the content of the paper.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at tykobaya@juntendo.ac.jp. Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toshiyuki Kobayashi, MD, Department of General Medicine, Zama General Hospital, 1-50-1, Sobudai, Zama City, Kanagawa 252-0011, Japan. tykobaya@juntendo.ac.jp
Telephone: +81-46-2331311 Fax: +81-46-2328934
Received: November 6, 2016
Peer-review started: November 10, 2016
First decision: November 30, 2016
Revised: December 21, 2016
Accepted: January 11, 2017
Article in press: January 13, 2017
Published online: February 26, 2017
Processing time: 109 Days and 2.7 Hours
Abstract
AIM

To investigate the association between carotid atherosclerosis and cystatin C (CysC) and to determine the optimal CysC cut-off value.

METHODS

One hundred twenty-eight subjects were included in this study. Atherosclerosis was defined as a maximum carotid plaque thickness (MCPT) of greater than 2 mm. A receiver operating characteristic curve analysis was used to determine the diagnostic value of serum CysC for atherosclerosis. The subjects were divided into two groups according to the CysC cut-off value. We screened for diabetes, hypertension, dyslipidemia, smoking status, alcohol consumption, and exercise behavior. The association between atherosclerosis and CysC levels was assessed using multivariate analysis.

RESULTS

The subjects were then divided into two groups according to the CysC cut-off value (0.73 mg/L). The median age of the high CysC group was 72 years (85% males), whereas that of the low CysC group was 61 years (63% males). The CysC levels were significantly correlated with Cr and estimated glomerular filtration rate (eGFR) values. Body-mass index, visceral fat area, hypertension, diabetes mellitus, and MCPT were significantly higher in the high CysC group than in the low CysC group. Furthermore, the eGFR was significantly lower in the high CysC group. Regarding lifestyle habits, only the exercise level was lower in the high CysC group than in the low CysC group. Multivariate analysis, adjusted for age and sex, revealed that high CysC levels were significantly associated with an MCPT of ≥ 2 mm (odds ratio: 2.92; 95%CI: 1.13-7.99).

CONCLUSION

Higher CysC levels were associated with an MCPT of ≥ 2 mm. The CysC cut-off value of 0.73 mg/L appears to aid in the diagnosis of atherosclerosis.

Keywords: Cystatin C; Atherosclerosis; Carotid plaque; Maximum carotid plaque thickness; Visceral fat

Core tip: Atherosclerosis is a leading worldwide cause of morbidity and mortality. The association between cystatin C (CysC) and atherosclerotic disorders remains controversial, and the cut-off value of CysC for atherosclerosis is unknown. Our study revealed that the optimal CysC cut-off point was 0.73 mg/L by receiver operating characteristic curve analysis. Higher CysC levels were significantly and independently correlated with an maximum carotid plaque thickness of ≥ 2 mm in multivariate analysis. Our data indicate that CysC could be a useful laboratory tool for predicting atherosclerosis during health checkups.