Relationship between cystatin C and coronary artery atherosclerosis progression differs by type 1 diabetes

Diabetes Technol Ther. 2010 Jan;12(1):25-33. doi: 10.1089/dia.2009.0086.


Background: Cystatin C has been proposed to better estimate renal function and predict cardiovascular disease (CVD) than serum creatinine. To expand on our previous report, we investigated whether the relationship of cystatin C to progression of coronary artery atherosclerosis (CA) differed between individuals with type 1 diabetes (T1D) and persons without diabetes.

Methods: Coronary artery calcium was measured twice over 2.4 +/- 0.4 years (n = 1,123, age = 39 +/- 9 years, 47% male, 45% T1D). Significant CA progression was defined as a > or = 2.5 increase in square root calcium volume score or development of clinical coronary artery disease. Stepwise multiple logistic regression was performed to investigate whether the association of cystatin C to CA progression differed by T1D status.

Results: The main finding and novelty of this article is that while the univariate association of cystatin C to CA progression was similar in T1D patients and persons without diabetes mellitus and in the expected direction (increased cystatin C as a biomarker of worsening renal function associated with CA progression), the association of cystatin C to progression of CA differed by T1D status (P = 0.01) after adjustment for other CVD risk factors. Unexpectedly, in persons without diabetes mellitus having relatively normal renal function, increased cystatin C was associated with decreased CA progression (odd ratio [OR] = 0.65, 95% confidence interval 0.44-0.96, P = 0.029) after adjustment, primarily due to adjustment for body mass index (BMI). Removal of BMI from this model resulted in a 49% change in the OR.

Conclusions: Our hypothesis-generating data suggest a complex relationship among cystatin C, BMI, and CA progression that requires further study.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Analysis of Variance
  • Atherosclerosis / complications
  • Atherosclerosis / epidemiology*
  • Calcinosis / epidemiology
  • Coronary Disease / complications
  • Coronary Disease / epidemiology*
  • Cystatin C / blood*
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / classification*
  • Diabetes Mellitus, Type 1 / complications
  • Diabetic Angiopathies / complications*
  • Disease Progression
  • Female
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Predictive Value of Tests
  • Reference Values
  • Regression Analysis
  • Risk Factors
  • Young Adult


  • Cystatin C