Editorial comment
Cystatin C: An underexplored biomarker that goes beyond renal function
Cistatina C: um biomarcador por explorar que vai para além da função renal
Maria João Andrade
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
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MetD: metabolic disturbances; MetS: metabolic syndrome.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ping Liu, Shujian Sui, Dongling Xu, Xiaowei Xing, Caixia Liu" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Ping" "apellidos" => "Liu" ] 1 => array:2 [ "nombre" => "Shujian" "apellidos" => "Sui" ] 2 => array:2 [ "nombre" => "Dongling" "apellidos" => "Xu" ] 3 => array:2 [ "nombre" => "Xiaowei" "apellidos" => "Xing" ] 4 => array:2 [ "nombre" => "Caixia" "apellidos" => "Liu" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255114001504" "doi" => "10.1016/j.repc.2014.01.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114001504?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914001755?idApp=UINPBA00004E" "url" => "/21742049/0000003300000078/v2_201411090043/S2174204914001755/v2_201411090043/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Cystatin C: An underexplored biomarker that goes beyond renal function" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "417" "paginaFinal" => "418" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Maria João Andrade" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Maria João" "apellidos" => "Andrade" "email" => array:1 [ 0 => "mjandrade@inblox.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Cistatina C: um biomarcador por explorar que vai para além da função renal" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The metabolic syndrome (MetS) is a multiplex risk factor that consists of several risk correlates of metabolic origin. In addition to atherogenic lipid profile, hypertension, glucose intolerance and abdominal obesity, the syndrome carries a prothrombotic and a proinflammatory state. Persons with the MetS are at essentially twice the risk for cardiovascular disease compared with those without the syndrome. It further raises the risk for type 2 diabetes about five-fold.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although there is still a lack of clarity in the definition of MetS (the National Cholesterol Education Program – Adult Treatment Panel III and the International Diabetes Federation use different criteria), the key clinical implication of a diagnosis of the syndrome is to decrease associated morbidity and mortality, through identification and management of its individual components.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> MetS is becoming increasingly common, affecting approximately 20–30% of the adult population in most countries.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Age, race and increased body weight, as well as socioeconomic and lifestyle factors such as diet, smoking, soft drink consumption and physical inactivity, are associated with an increased risk of MetS.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although the exact mechanism underlying MetS has not yet been fully elucidated, many studies have shown that it is strongly associated with inflammation, insulin sensitivity, endothelial dysfunction, renal dysfunction and oxidative stress. As a result, several biological markers have been identified as risk factors for cardiovascular disease and are associated with increased risk of MetS.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The level of cystatin C (CysC) in the bloodstream has been used clinically mainly as a biomarker of glomerular filtration and early renal dysfunction. However, recent reports suggest that CysC can predict cardiovascular risk through atherosclerosis and obesity, independently of renal function.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Serum CysC is elevated in obese subjects of both genders, independently of reduced estimated glomerular filtration rate (eGFR).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Besides reduced eGFR and adiposity, several other factors are known to influence circulating CysC concentrations, including older age.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In a recent study, CysC was measured in 1502 individuals included in the Malmö Diet and Cancer cardiovascular cohort who were free from MetS at baseline and subsequently underwent a follow-up examination after a median of 16 years. During follow-up, 428 subjects developed new-onset MetS. The only MetS component prospectively significantly associated with increased baseline CysC levels was the incidence and long-term progression of abdominal obesity, indicating that the association between CysC levels and incident MetS might be mediated to a large extent by visceral fat.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Ping Liu et al. of Shandong University present an article entitled “Clinical analysis of the relationship between cystatin C and MetS in the elderly”.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The authors studied 380 elderly individuals divided into three groups: (1) patients with MetS (n=135); (2) patients without MetS but with at least one diagnostic criterion of MetS (n=142); and (3) a control group of healthy elderly persons (n=103). Several variables related to weight, lipid profile, glucose metabolism and blood pressure were obtained, as well as measurement of CysC, serum creatinine and microalbuminuria. The authors concluded that CysC was significantly associated with MetS in the elderly and that as MetS scores rose, serum CysC levels increased. One of the limitations of the study pointed out by the authors in the discussion is the non-inclusion of inflammatory variables. A number of recent studies have demonstrated a correlation between inflammatory mediators and MetS components, and an association between inflammatory markers and the severity of MetS has also been reported.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> These indicators of inflammation in MetS may be early markers of the development of CVD.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In a recent analysis of the prospective Multiethnic Study of Atherosclerosis cohort which included 6814 men and women aged 45–84 years old followed for a period of 5.5 years, Agarwal et al. examined the joint association of chronic kidney disease (CKD) and MetS with incident cardiovascular disease (CVD). They demonstrated that CKD and MetS were independent predictors of CVD (hazard ratio, 2.02 for CKD, and 2.55 for MetS), with an additive interaction of CKD and MetS (adjusted HR for the CKD+/MetS+ group 5.56 compared to the CKD−/MetS− group).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The most important merit of the study by Ping Liu et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> is to draw attention to the expanded role of serum cystatin C levels beyond estimation of renal function. Although more research is needed, cystatin C appears to be of value in the cardiovascular risk stratification of elderly patients with MetS or even with only some of the components of its diagnostic criteria.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 5 | 11 |
| 2024 October | 30 | 25 | 55 |
| 2024 September | 54 | 22 | 76 |
| 2024 August | 50 | 29 | 79 |
| 2024 July | 58 | 31 | 89 |
| 2024 June | 52 | 19 | 71 |
| 2024 May | 70 | 23 | 93 |
| 2024 April | 25 | 26 | 51 |
| 2024 March | 21 | 22 | 43 |
| 2024 February | 32 | 30 | 62 |
| 2024 January | 18 | 34 | 52 |
| 2023 December | 27 | 27 | 54 |
| 2023 November | 28 | 25 | 53 |
| 2023 October | 24 | 15 | 39 |
| 2023 September | 18 | 20 | 38 |
| 2023 August | 22 | 17 | 39 |
| 2023 July | 26 | 16 | 42 |
| 2023 June | 17 | 15 | 32 |
| 2023 May | 43 | 39 | 82 |
| 2023 April | 12 | 5 | 17 |
| 2023 March | 25 | 17 | 42 |
| 2023 February | 22 | 27 | 49 |
| 2023 January | 21 | 16 | 37 |
| 2022 December | 26 | 19 | 45 |
| 2022 November | 29 | 26 | 55 |
| 2022 October | 26 | 16 | 42 |
| 2022 September | 24 | 41 | 65 |
| 2022 August | 23 | 41 | 64 |
| 2022 July | 22 | 35 | 57 |
| 2022 June | 21 | 25 | 46 |
| 2022 May | 35 | 42 | 77 |
| 2022 April | 31 | 24 | 55 |
| 2022 March | 21 | 34 | 55 |
| 2022 February | 17 | 24 | 41 |
| 2022 January | 21 | 22 | 43 |
| 2021 December | 15 | 28 | 43 |
| 2021 November | 28 | 26 | 54 |
| 2021 October | 19 | 42 | 61 |
| 2021 September | 24 | 42 | 66 |
| 2021 August | 25 | 30 | 55 |
| 2021 July | 18 | 26 | 44 |
| 2021 June | 19 | 20 | 39 |
| 2021 May | 23 | 38 | 61 |
| 2021 April | 22 | 20 | 42 |
| 2021 March | 62 | 12 | 74 |
| 2021 February | 47 | 18 | 65 |
| 2021 January | 20 | 15 | 35 |
| 2020 December | 33 | 12 | 45 |
| 2020 November | 21 | 12 | 33 |
| 2020 October | 14 | 6 | 20 |
| 2020 September | 53 | 15 | 68 |
| 2020 August | 18 | 2 | 20 |
| 2020 July | 39 | 3 | 42 |
| 2020 June | 21 | 5 | 26 |
| 2020 May | 28 | 3 | 31 |
| 2020 April | 40 | 28 | 68 |
| 2020 March | 34 | 8 | 42 |
| 2020 February | 50 | 14 | 64 |
| 2020 January | 23 | 4 | 27 |
| 2019 December | 17 | 6 | 23 |
| 2019 November | 30 | 1 | 31 |
| 2019 October | 22 | 5 | 27 |
| 2019 September | 11 | 6 | 17 |
| 2019 August | 26 | 6 | 32 |
| 2019 July | 28 | 12 | 40 |
| 2019 June | 18 | 7 | 25 |
| 2019 May | 36 | 9 | 45 |
| 2019 April | 12 | 14 | 26 |
| 2019 March | 86 | 9 | 95 |
| 2019 February | 26 | 6 | 32 |
| 2019 January | 23 | 6 | 29 |
| 2018 December | 36 | 9 | 45 |
| 2018 November | 69 | 12 | 81 |
| 2018 October | 136 | 12 | 148 |
| 2018 September | 50 | 10 | 60 |
| 2018 August | 27 | 13 | 40 |
| 2018 July | 26 | 3 | 29 |
| 2018 June | 37 | 14 | 51 |
| 2018 May | 24 | 4 | 28 |
| 2018 April | 44 | 9 | 53 |
| 2018 March | 38 | 13 | 51 |
| 2018 February | 17 | 11 | 28 |
| 2018 January | 28 | 12 | 40 |
| 2017 December | 33 | 14 | 47 |
| 2017 November | 25 | 7 | 32 |
| 2017 October | 17 | 14 | 31 |
| 2017 September | 28 | 9 | 37 |
| 2017 August | 40 | 19 | 59 |
| 2017 July | 22 | 16 | 38 |
| 2017 June | 36 | 9 | 45 |
| 2017 May | 24 | 14 | 38 |
| 2017 April | 26 | 10 | 36 |
| 2017 March | 37 | 65 | 102 |
| 2017 February | 21 | 5 | 26 |
| 2017 January | 24 | 3 | 27 |
| 2016 December | 37 | 12 | 49 |
| 2016 November | 9 | 4 | 13 |
| 2016 October | 26 | 9 | 35 |
| 2016 September | 15 | 3 | 18 |
| 2016 August | 6 | 2 | 8 |
| 2016 July | 10 | 10 | 20 |
| 2016 June | 6 | 2 | 8 |
| 2016 May | 13 | 2 | 15 |
| 2016 April | 21 | 11 | 32 |
| 2016 March | 27 | 9 | 36 |
| 2016 February | 35 | 24 | 59 |
| 2016 January | 33 | 24 | 57 |
| 2015 December | 30 | 17 | 47 |
| 2015 November | 31 | 13 | 44 |
| 2015 October | 36 | 17 | 53 |
| 2015 September | 28 | 10 | 38 |
| 2015 August | 24 | 6 | 30 |
| 2015 July | 17 | 7 | 24 |
| 2015 June | 10 | 1 | 11 |
| 2015 May | 30 | 4 | 34 |
| 2015 April | 20 | 13 | 33 |
| 2015 March | 15 | 10 | 25 |
| 2015 February | 15 | 9 | 24 |
| 2015 January | 23 | 4 | 27 |
| 2014 December | 32 | 12 | 44 |
| 2014 November | 23 | 4 | 27 |
| 2014 October | 45 | 10 | 55 |
| 2014 September | 31 | 6 | 37 |
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