Cystatin C as a determinant of fasting plasma total homocysteine levels in coronary artery disease patients with normal serum creatinine

被引:45
作者
Bostom, AG
Bausserman, L
Jacques, PF
Liaugaudas, G
Selhub, J
Rosenberg, IH
机构
[1] Brown Univ, Mem Hosp Rhode Isl, Div Gen Internal Med, Pawtucket, RI 02860 USA
[2] Brown Univ, Mem Hosp Rhode Isl, Div Cardiol, Pawtucket, RI 02860 USA
[3] Tufts Univ, USDA, Human Nutr Res Ctr Aging, Boston, MA 02111 USA
[4] Miriam Hosp, Lipid Res Lab, Providence, RI 02906 USA
关键词
coronary arteriosclerosis; renal function; homocysteine; determinants;
D O I
10.1161/01.ATV.19.9.2241
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Serum creatinine, a surrogate for both renal function and homocysteine generation, is a determinant of fasting plasma total homocysteine levels in coronary artery disease (CAD) patients. We hypothesized that among stable-CAD patients with normal creatinine levels (ie, less than or equal to 1.4 mg/dL), serum cystatin C, a more sensitive indicator of glomerular filtration rate, would better predict fasting total homocysteine levels in comparison with serum creatinine. Fasting plasma total homocysteine, folate, vitamin B-12, and pyridoxal 5'-phosphate levels, along with serum cystatin C, creatinine, and albumin levels, were determined in 164 consecutive stable-CAD patients (mean+/-SD age, 61+/-9 years; 78.7% men) whose serum creatinine level was less than or equal to 1.4 mg/dL. All subjects were examined at least 3 to 4 months after the widespread availability of cereal grain flour products fortified with folic acid. General linear modeling with ANCOVA revealed that serum cystatin C (P<0.001), B-12 (P<0.001), age (P=0.002), albumin (P=0.008), and sex (P=0.024) were independent determinants of fasting total homocysteine levels. Cystatin C alone determined over half of the variability (ie, R-2) in total homocysteine levels accounted for by these 5 independent regressors, In contrast, creatinine, folate, and pyridoxal 5'-phosphate were not independently predictive of fasting total homocysteine levels (P>0.2). Consistent with the impact of folic acid fortification of cereal grain flour in the general population, only 1 of the CAD subjects (0.6%) had a plasma folate level <3 ng/mL. We conclude that serum cystatin C levels may reflect subtle decreases in renal function that independently predict fasting total homocysteine levels among stable-CAD patients with normal serum creatinine.
引用
收藏
页码:2241 / 2244
页数:4
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