Association between cystatin C and major adverse cardiac events in patients with ischemic heart disease and type 2 diabetes mellitus after acute coronary syndrome

Authors

  • S. A. Serik GI “L. T. Mala Therapy National Institute of the National Academy of Medical Sciences of Ukraine”, Kharkiv, Ukraine,
  • T. H. Ovrakh GI “L. T. Mala Therapy National Institute of the National Academy of Medical Sciences of Ukraine”, Kharkiv, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2019.3.168962

Keywords:

myocardial ischemia, type 2 diabetes mellitus, cystatin C

Abstract

 

Purpose. To evaluate the level of cystatin C and its association with the risk of developing repeated major adverse cardiac events (MACE) in patients with ischemic heart disease (IHD) and preserved kidney function in combination with type 2 diabetes mellitus (DM) within 12 months after acute coronary syndrome (ACS).

Materials and methods. A total of 88 patients, aged 30–75 years, (59 patients with DM and 29 patients without DM) with prior ACS (unstable angina or myocardial infarction) in the previous 4–6 weeks were enrolled. The control group consisted of 15 healthy persons. The follow-up period was 11 months.

Results. Cystatin C level in patients with DM was higher than in patients without DM (2057.69 ± 107.56 ng/ml vs 1376.57 ± 81.11 ng/ml, P < 0.05). In patients with CHD without diabetes, the level of cystatin C was although higher than in the control group, but not statistically significantly (P > 0.05).

During the follow-up period, the MACE rate in DM patients was higher than in patients without DM, 40.68 % (n = 24) and 10.34 % (n = 3), respectively, P < 0.05. According to the ROC analysis, cystatin C level of more than 1942.62 ng/ml was associated with MACE occurrence in DM patients within 12 months after ACS, the sensitivity of the method was 82.60 %, specificity – 64.30 %. As a result of the multivariate regression analysis adjusted for age and sex, it has been identified that cystatin C was an independent predictor for MACE occurrence in DM patients within 12 months after ACS (OR 3ю78, 95 % CI [1.51, 7.41], P = 0.001).

Conclusions. Cystatin C was an independent predictor for MACE after ACS in patients with DM and preserved kidney function.

 

References

Cziraky, M. J., Reddy, V. S., Luthra, R., Xu, Y., Wilhelm, K., Power, T. P., & Fisher, M. D. (2015). Clinical Outcomes and Medication Adherence in Acute Coronary Syndrome Patients With and Without Type 2 Diabetes Mellitus: A Longitudinal Analysis 2006–2011. Journal of Managed Care & Specialty Pharmacy, 21(6), 470–477. doi: 10.18553/jmcp.2015.21.6.470

Dalby, A., Gottlieb, S., Cyr, D., Magnus Ohman, E., McGuire, D., Ruzyllo, W., et al. (2017). Dual antiplatelet therapy in patients with diabetes and acute coronary syndromes managed without revascularization. American Heart Journal, 188, 156–166. doi: 10.1016/j.ahj.2017.03.015

De Servi, S., Mariani, G., Piatti, L., Leoncini, M., Rubartelli, P., Pitì, A., et al. (2014). Time course changes of cystatin C and inflammatory and biochemical markers in non-ST-elevation acute coronary syndromes. Journal of Cardiovascular Medicine, 15(1), 42–47. doi: 10.2459/JCM.0b013e328365a275

Palmer, S., Di Micco, L., Razavian, M., Craig, J., Perkovic, V., Pellegrini, F., et al. (2012). Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease. Annals of Internal Medicine, 156(6), 445–59. doi: 10.7326/0003-4819-156-6-201203200-00007

Angiolillo, D., Bernardo, E., Capodanno, D., Vivas, D., Sabaté, M., Ferreiro, J., et al. (2010). Impact of Chronic Kidney Disease on Platelet Function Profiles in Diabetes Mellitus Patients With Coronary Artery Disease Taking Dual Antiplatelet Therapy. Journal of the American College of Cardiology, 55(11), 1139–46. doi: 10.1016/j.jacc.2009.10.043

Zhang, Y., Li, M., Tang, J., & Chen, X. (2017). Pharmacokinetic and Pharmacodynamic Responses to Clopidogrel: Evidences and Perspectives. International Journal of Environmental Research and Public Health, 14(3). pii: E301. doi: 10.3390/ijerph14030301

Mariani, M., Mariani, G., & De Servi, St. (2014) Clinical Significance of Cystatin C in Acute Coronary Syndromes: Something More Than a Marker of Renal Function?. Inflammation and Cell Signaling., 1(4), е. 229.

Angelidis, C., Deftereos, S., Giannopoulos, G., Anatoliotakis, N., Bouras, G., Hatzis, G., et al. (2013) Cystatin C: an emerging biomarker in cardiovascular disease. Current Topics in Medicinal Chemistry. Curr Top Med Chem, 13(2), 164–179. doi: 10.2174/1568026611313020006

Sai, E., Shimada, K., Miyauchi, K., Masaki, Y., Kojima, T., Miyazaki, T., et al. (2015). Increased cystatin C levels as a risk factor of cardiovascular events in patients with preserved estimated glomerular filtration rate after elective percutaneous coronary intervention with drug-eluting stents. Heart and Vessels, 31(5), 694–701. doi: 10.1007/s00380-015-0674-0

Fu, Z., Xue, H., Guo, J., Chen, L., Dong, W., Gai, L., et al. (2013). Long-term prognostic impact of cystatin c on acute coronary syndrome octogenarians with diabetes mellitus. Cardiovascular Diabetology, 12, 157. doi: 10.1186/1475-2840-12-157

Fiseha, T. (2015). Clinical Significance of Cystatin C-Based Estimates of Renal Function in Type 2 Diabetic Patients: Review. Annals of Clinical and Laboratory Research, 3(2). doi: 10.21767/2386-5180.100011

Triki, S., Fekih, O., Hellara, I., Neffati, F., Douki, W., Hamda, K. B., et al. (2013). Association between serum cystatin C levels and cardiovascular disease in type 2 diabetic patients. Ann Biol Clin (Paris), 71(4), 438–42. doi: 10.1684/abc.2013.0857

Liu, F., Shen, J., Zhao, J., Zeng, H., Li, L., Zhao, J., et al. (2013). Cystatin C: A Strong Marker for Lower Limb Ischemia in Chinese Type 2 Diabetic Patients? PLoS ONE, 8(7), e66907. doi: 10.1371/journal.pone.0066907

Magnusson, M., Hedblad, B., Engström, G., Persson, M., Nilsson, P., & Melander, O. (2013). High levels of cystatin C predict the metabolic syndrome: the prospective Malmö Diet and Cancer Study. Journal of Internal Medicine, 274(2), 192–9. doi: 10.1111/joim.12051

Reutens, A., Bonnet, F., Lantieri, O., Roussel, R., & Balkau, B. (2013). The association between cystatin C and incident type 2 diabetes is related to central adiposity. Nephrol Dial Transplant, 28(7), 1820–1829. doi: 10.1093/ndt/gfs561

Magnusson, M., Molvin, J., Engström, G., Svensson-Färbom, P., Persson, M., Christensson, A., et al. (2016). Cystatin C and Risk of Diabetes and the Metabolic Syndrome – Biomarker and Genotype Association Analyses. PLOS ONE, 11(5), e0155735. doi: 10.1371/journal.pone.0155735

Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. L., Castro, A. F., Feldman, H. I., et al. (2009). A new equation to estimate glomerular filtration rate. Ann Intern Med, 150(9), 604–612.

Hall, A., Håkansson, K., Mason, R. W., Grubb, A., & Abrahamson, M. (1995). Structural basis for the biological specificity of cystatin C. Identification of leucine 9 in the N-terminal binding region as a selectivity-conferring residue in the inhibition of mammalian cysteine peptidases. Journal of Biological Chemistry., 270(10), 5115–5121. doi: 10.1074/jbc.270.10.5115

Angelidis, C., Deftereos, S., Giannopoulos, G., Anatoliotakis, N., Bouras, G., Hatzis, G., et al. (2013). Cystatin C: an emerging biomarker in cardiovascular disease. Current Topics in Medicinal Chemistry, 13(2), 164–179.

How to Cite

1.
Serik SA, Ovrakh TH. Association between cystatin C and major adverse cardiac events in patients with ischemic heart disease and type 2 diabetes mellitus after acute coronary syndrome. Zaporozhye Medical Journal [Internet]. 2019May31 [cited 2024Dec.25];(3). Available from: http://zmj.zsmu.edu.ua/article/view/168962

Issue

Section

Original research