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Editorials

Serum Cystatin C, Renal Filtration Function, and Left Ventricular Remodeling

Mark D. McMurray, MD; Justin E. Trivax, MD and Peter A. McCullough, MD, MPH

From the Department of Medicine, Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Royal Oak, Mich.

Correspondence to Peter A. McCullough, MD, MPH, Division of Nutrition and Preventive Medicine, William Beaumont Hospital, 4949 Coolidge, Royal Oak, MI 48073. E-mail pmc975@yahoo.com

Key Words: hypertension, renal • kidney

An extract of the first 250 words of the full text is provided, because this article has no abstract.

It is estimated that heart failure (HF) affects 5.7 million Americans and will have an estimated cost of $34.8 billion in 2009.¹ However, definitions of HF are mainly symptom based and, therefore, may lead to a gross underestimation of the actual prevalence. One study has shown that only 50% of people with echocardiographic evidence of left ventricular (LV) dysfunction are symptomatic.²

Article see p 98

It is now accepted that there is a link between renal dysfunction and heart disease, although physiological mechanisms remain unclear. The incidence and prevalence of chronic kidney disease are increasing, and it is estimated that 26 million Americans now have chronic kidney disease.¹ From a public health standpoint, HF and chronic kidney disease are similar in that the underlying pathology is underway long before symptoms are manifested, thereby causing them to be largely underdiagnosed in their early stages. Any advance or improvement in early detection of HF or chronic kidney disease could have enormous potential to reduce the morbidity and mortality from these treatable diseases.

The Dallas Heart Study showed that serum levels of cystatin C were independently associated with LV mass, concentricity, and wall thickness as measured by MRI.³ Male gender, hypertension, and use of antihypertensive medications were all associated with elevations of cystatin C. However, even after adjustment for these and other traditional risk factors, including estimated glomerular filtration rate (eGFR), the associations of cystatin C with a pathological cardiac phenotype persisted. These findings show that the risk of HF predicted by elevations . . . [Full Text of this Article]

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