Cystatin C and risk of vascular and nonvascular mortality: a prospective cohort study of older men

J Intern Med. 2010 Aug;268(2):145-54. doi: 10.1111/j.1365-2796.2010.02214.x. Epub 2010 Jan 20.


Objective: To assess the relevance of cystatin C, as a marker of mild-to-moderate renal impairment, for vascular and nonvascular mortality in older people.

Design: Prospective cohort study.

Setting: Re-survey in 1997 to 1998 of survivors in the 1970 Whitehall study of London civil servants.

Subjects: Five thousand three hundred and seventy-one men (mean age at resurvey: 77 years) who took part in the resurvey and had plasma cystatin C concentration measured.

Main outcome measures: Cause-specific mortality over subsequent 11 years (1997 to 2008).

Methods: Cox regression was used to estimate the associations of cystatin C with vascular and nonvascular mortality, before and after adjustment for prior disease and other risk factors (including lifetime blood pressure).

Results: During an 11.0-year follow-up period, there were 1171 deaths from vascular causes [26 per 1000 per year (py)] and 1615 deaths from nonvascular causes (36 per 1000 py). Compared with men with cystatin C in the bottom fifth of the distribution, men in the top 10th had about two-fold higher mortality rates from vascular and nonvascular mortality (fully adjusted P both <0.001) even after adjustment for prior disease and all measured confounders, including lifetime blood pressure. The fully adjusted relative risks per 50% higher cystatin C concentrations were 1.66 [95% CI 1.48 to 1.85] for vascular mortality, 1.92 [95% CI 1.66 to 2.22] for ischaemic heart disease mortality and 1.46 [95% CI 1.31 to 1.61] for nonvascular mortality.

Conclusions: In older men, plasma concentration of cystatin C, probably as a marker of mild renal disease, is a strong independent predictor of both vascular and nonvascular mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aging / blood
  • Biomarkers / blood
  • Cardiovascular Diseases / mortality
  • Cystatin C / blood*
  • Epidemiologic Methods
  • Humans
  • Kidney Diseases / mortality
  • London / epidemiology
  • Male
  • Middle Aged
  • Mortality*
  • Prognosis


  • Biomarkers
  • Cystatin C