A lower eGFRcystatin C/eGFRcreatinine ratio is associated with greater cardiovascular risk (higher Framingham Risk Score) in Chinese patients with newly diagnosed type 2 diabetes mellitus

Background: Cardiovascular disease (CVD) is the leading cause of mortality in type 2 diabetes mellitus (T2DM) patients. Shrunken pore syndrome (SPS) is defined as eGFR(cystatin C)/eGFR(creatinine) ratio <0.70 and predicts high CVD mortality. The Framingham Risk Score (FRS) is used to estimate an individual's 10-year CVD risk. This study investigated the association between FRS and eGFR(cystatin C)/eGFR(creatinine) ratio in T2DM patients. Methods: Patients aged 18-80 years who were newly diagnosed with T2DM were included in this retrospective study. Ordinal logistic regression analysis was used to investigate the association between risk factors of T2DM and FRS. A Generalized Linear Model was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: There were 270 patients included in the study. Only 27 patients (10%) met the diagnostic criteria of SPS. Ordinal logistic regression analysis showed that SPS was not correlated with FRS risk (OR = 1.99, 95%CI = 0.94-4.23, p = 0.07), whereas eGFR(cystatin C)/eGFR(creatinine) (OR = 0.86, 95%CI = 0.77-0.97, p = 0.01) showed a significant negative association with FRS risk. Compared with eGFR(cystatin C)/eGFR(creatinine)>0.85, eGFR(cystatin C)/eGFR(creatinine)<= 0.85 increased FRS risk (OR = 1.95, 95%CI = 1.18-3.21, p < 0.01). After adjustment for confounding factors, increased eGFR(cystatin C)/eGFR(creatinine) ratio was associated with decreased FRS risk when considered as a continuous variable (OR = 0.87, 95%CI = 0.77-0.99, p = 0.03). The FRS risk in patients with eGFR(cystatin C)/eGFR(creatinine)<= 0.85 is 1.86 times higher than that in patients with eGFR(cystatin C)/eGFR(creatinine)>0.85 (OR = 1.86, 95%CI = 1.08-3.21, p = 0.03). Conclusions: In the current study, no significant association between SPS and FRS was identified. However, lower eGFR(cystatin C)/eGFR(creatinine) and eGFR(cystatin C)/eGFR(creatinine)<= 0.85 were associated with a significantly increased CVD risk in T2DM.