Patients with
chronic kidney disease (CKD) are at high risk for developing
cardiovascular disease (CVD) and cardiovascular events.
Cystatin C, a
protease inhibitor synthesized in all nucleated cells, has been proposed as a replacement for serum
creatinine for the assessment of renal function, particularly to detect small reductions in glomerular filtration rate. This report presents a review of the role of
cystatin C as a predictor of cardiovascularis. Patients with higher circulating
cystatin C concentrations appear to have an increased cardiovascular risk profile, i.e., they are older and have a higher prevalence of systemic
hypertension,
dyslipidemia, documented CVD, increased body mass index, and increased concentrations of
C-reactive protein. Prospective studies have shown, in various clinical scenarios, that patients with increased
cystatin C are at a higher risk of developing both CVD and CKD. Importantly,
cystatin C appears to be a useful marker or identifying individuals at a higher risk of cardiovascular events among patients belonging ot a relatively lox-risk category as assessed by both
creatinine and estimated glomerular filtration rate values. Of interest, elastolytic
proteases and their inhibitors, in particular
cystatin C, have been shown to be directly involved in the atherosclerotic process. Increases concentrations of
cystatin C appear to be indicative of preclinical
kidney disease associated with adverse outcomes. Clinical studies involving direct glomerular filtration rate measurements are required to ascertain both the true role of this promising marker in renal disease and whether atherogenic factors like
inflammation can account for increases in
cystatin C concentrations, thus explaining its predictive value in CVD.