摘要
The association of circulating levels of cystatin C(CysC)and risk of recurrent cardiovascular events in patients with preexisting coronary heart disease are uncertain.To qualitatively and quantitatively address this issue,we performed a random meta-analysis of results from prospective studies on the topic.We searched electronic and printed sources(up to 16 October 2011)using keywords and retrieved articles for seven prospective studies according to the selection criteria.Data were abstracted and meta-analysis was performed using the random-effects model(RevMan 5.0.23 software).The cohorts involved 4,576 patients with preexisting coronary heart disease(CHD)and normal or mild chronic kidney disease,and follow-up ranged from 5.6 to 40.6 months.Highest versus lowest baseline CysC level was significantly associated with increased risk of cardiovascular events(OR 2.30,95%CI 1.80–2.94),all-cause mortality(OR 5.69,95%CI 3.70–8.74),but not with recurrent MI(OR 1.75,95%CI 0.77–4.00).In heterogeneity testing for studies reporting cardiovascular events and all-cause mortality,no significant heterogeneity was found,and exclusion of any single study did not alter the overall finding.For risk of recurrent MI,significant heterogeneity was found among the five trials(v2=13.16,P=0.01,I2=70%)and exclusion of the Taglieri et al.[12]study from the analysis resulted in a rise in relative risk(OR 2.36,95%CI 1.09–5.15).In conclusion,for patients with established CHD,high baseline level of CysC is associated with increased risk of cardiovascular events and all-cause death during long-term follow-up.
The association of circulating levels of cystatin C （CysC） and risk of recurrent cardiovascular events in patients with preexisting coronary heart disease are uncertain. To qualitatively and quantitatively address this issue, we performed a random meta-analysis of results from prospective studies on the topic. We searched elec- tronic and printed sources （up to 16 October 2011） using keywords and retrieved articles for seven prospective studies according to the selection criteria. Data were abstracted and meta-analysis was performed using the random-effects model （RevMan 5.0.23 software）. The cohorts involved 4,576 patients with preexisting coronary heart disease （CHD） and normal or mild chronic kidney disease, and follow-up ranged from 5.6 to 40.6 months. Highest versus lowest baseline CysC level was signifi- cantly associated with increased risk of cardiovascular events （OR 2.30, 95 % CI 1.80-2.94）, all-cause mortality （OR 5.69, 95 % CI 3.70-8.74）, but not with recurrent MI （OR 1.75, 95 % CI 0.77-4.00）. In heterogeneity testing for studies reporting cardiovascular events and all-cause mor- tality, no significant heterogeneity was found, and exclu- sion of any single study did not alter the overall finding. For risk of recurrent MI, significant heterogeneity was found among the five trials （Z2= 13.16, P=0.01, 12 = 70 %） and exclusion of the Taglieri et al. [12] study from the analysis resulted in a rise in relative risk （OR 2.36, 95 % CI 1.09-5.15）. In conclusion, for patients with established CHD, high baseline level of CysC is associated with increased risk of cardiovascular events and all-cause death during long-term follow-up.
基金
supported by the National Basic Research Program of China(2010CB732605)
the Department of Science and Technology of Shandong Province(Y2007C075,ZR2010HQ017,and 2008RKB060)
the Health Department of Shandong Province(Shandong Provincial Outstanding Medical Academic Professional Program,1020 Program,and 2009HD011)
an Independent Innovation Foundation of Shandong University(2010TS082)
a grant from the Jinan Science and Technology Bureau(201102073)
