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" => "S2174204914001755" "doi" => "10.1016/j.repce.2014.01.016" "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/S2174204914001755?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114001504?idApp=UINPBA00004E" "url" => "/08702551/0000003300000078/v4_201411060056/S0870255114001504/v4_201411060056/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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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 6 | 13 |
| 2024 Outubro | 36 | 31 | 67 |
| 2024 Setembro | 48 | 22 | 70 |
| 2024 Agosto | 47 | 30 | 77 |
| 2024 Julho | 35 | 37 | 72 |
| 2024 Junho | 51 | 28 | 79 |
| 2024 Maio | 46 | 16 | 62 |
| 2024 Abril | 37 | 19 | 56 |
| 2024 Maro | 40 | 18 | 58 |
| 2024 Fevereiro | 33 | 34 | 67 |
| 2024 Janeiro | 25 | 32 | 57 |
| 2023 Dezembro | 33 | 20 | 53 |
| 2023 Novembro | 38 | 24 | 62 |
| 2023 Outubro | 25 | 22 | 47 |
| 2023 Setembro | 19 | 18 | 37 |
| 2023 Agosto | 36 | 18 | 54 |
| 2023 Julho | 43 | 12 | 55 |
| 2023 Junho | 24 | 9 | 33 |
| 2023 Maio | 39 | 29 | 68 |
| 2023 Abril | 20 | 5 | 25 |
| 2023 Maro | 32 | 22 | 54 |
| 2023 Fevereiro | 32 | 28 | 60 |
| 2023 Janeiro | 20 | 18 | 38 |
| 2022 Dezembro | 25 | 22 | 47 |
| 2022 Novembro | 53 | 34 | 87 |
| 2022 Outubro | 26 | 16 | 42 |
| 2022 Setembro | 36 | 31 | 67 |
| 2022 Agosto | 27 | 41 | 68 |
| 2022 Julho | 26 | 35 | 61 |
| 2022 Junho | 16 | 22 | 38 |
| 2022 Maio | 22 | 35 | 57 |
| 2022 Abril | 33 | 34 | 67 |
| 2022 Maro | 20 | 43 | 63 |
| 2022 Fevereiro | 23 | 25 | 48 |
| 2022 Janeiro | 24 | 22 | 46 |
| 2021 Dezembro | 21 | 36 | 57 |
| 2021 Novembro | 25 | 33 | 58 |
| 2021 Outubro | 30 | 46 | 76 |
| 2021 Setembro | 30 | 31 | 61 |
| 2021 Agosto | 26 | 31 | 57 |
| 2021 Julho | 20 | 27 | 47 |
| 2021 Junho | 18 | 27 | 45 |
| 2021 Maio | 27 | 26 | 53 |
| 2021 Abril | 52 | 57 | 109 |
| 2021 Maro | 81 | 18 | 99 |
| 2021 Fevereiro | 67 | 12 | 79 |
| 2021 Janeiro | 51 | 11 | 62 |
| 2020 Dezembro | 27 | 11 | 38 |
| 2020 Novembro | 32 | 13 | 45 |
| 2020 Outubro | 12 | 10 | 22 |
| 2020 Setembro | 43 | 9 | 52 |
| 2020 Agosto | 15 | 6 | 21 |
| 2020 Julho | 30 | 6 | 36 |
| 2020 Junho | 23 | 3 | 26 |
| 2020 Maio | 30 | 6 | 36 |
| 2020 Abril | 37 | 12 | 49 |
| 2020 Maro | 29 | 7 | 36 |
| 2020 Fevereiro | 38 | 11 | 49 |
| 2020 Janeiro | 18 | 5 | 23 |
| 2019 Dezembro | 21 | 8 | 29 |
| 2019 Novembro | 26 | 2 | 28 |
| 2019 Outubro | 22 | 3 | 25 |
| 2019 Setembro | 17 | 5 | 22 |
| 2019 Agosto | 18 | 2 | 20 |
| 2019 Julho | 42 | 12 | 54 |
| 2019 Junho | 17 | 6 | 23 |
| 2019 Maio | 33 | 19 | 52 |
| 2019 Abril | 15 | 18 | 33 |
| 2019 Maro | 39 | 8 | 47 |
| 2019 Fevereiro | 73 | 11 | 84 |
| 2019 Janeiro | 12 | 8 | 20 |
| 2018 Dezembro | 31 | 11 | 42 |
| 2018 Novembro | 56 | 15 | 71 |
| 2018 Outubro | 98 | 10 | 108 |
| 2018 Setembro | 38 | 14 | 52 |
| 2018 Agosto | 44 | 14 | 58 |
| 2018 Julho | 29 | 7 | 36 |
| 2018 Junho | 49 | 5 | 54 |
| 2018 Maio | 64 | 10 | 74 |
| 2018 Abril | 63 | 7 | 70 |
| 2018 Maro | 86 | 14 | 100 |
| 2018 Fevereiro | 41 | 7 | 48 |
| 2018 Janeiro | 110 | 15 | 125 |
| 2017 Dezembro | 86 | 15 | 101 |
| 2017 Novembro | 40 | 10 | 50 |
| 2017 Outubro | 28 | 10 | 38 |
| 2017 Setembro | 34 | 8 | 42 |
| 2017 Agosto | 34 | 13 | 47 |
| 2017 Julho | 24 | 10 | 34 |
| 2017 Junho | 46 | 15 | 61 |
| 2017 Maio | 36 | 8 | 44 |
| 2017 Abril | 9 | 2 | 11 |
| 2017 Maro | 21 | 8 | 29 |
| 2017 Fevereiro | 17 | 3 | 20 |
| 2017 Janeiro | 22 | 3 | 25 |
| 2016 Dezembro | 16 | 4 | 20 |
| 2016 Novembro | 12 | 5 | 17 |
| 2016 Outubro | 20 | 5 | 25 |
| 2016 Setembro | 15 | 6 | 21 |
| 2016 Agosto | 7 | 2 | 9 |
| 2016 Julho | 6 | 4 | 10 |
| 2016 Junho | 17 | 6 | 23 |
| 2016 Maio | 2 | 7 | 9 |
| 2016 Abril | 20 | 1 | 21 |
| 2016 Maro | 30 | 5 | 35 |
| 2016 Fevereiro | 42 | 19 | 61 |
| 2016 Janeiro | 30 | 7 | 37 |
| 2015 Dezembro | 37 | 10 | 47 |
| 2015 Novembro | 23 | 11 | 34 |
| 2015 Outubro | 28 | 12 | 40 |
| 2015 Setembro | 29 | 13 | 42 |
| 2015 Agosto | 32 | 12 | 44 |
| 2015 Julho | 21 | 2 | 23 |
| 2015 Junho | 14 | 5 | 19 |
| 2015 Maio | 20 | 6 | 26 |
| 2015 Abril | 40 | 7 | 47 |
| 2015 Maro | 19 | 10 | 29 |
| 2015 Fevereiro | 35 | 11 | 46 |
| 2015 Janeiro | 27 | 8 | 35 |
| 2014 Dezembro | 35 | 26 | 61 |
| 2014 Novembro | 35 | 11 | 46 |
| 2014 Outubro | 47 | 20 | 67 |
| 2014 Setembro | 101 | 51 | 152 |
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