Independent associations of urinary albumin-to-creatinine ratio and serum cystatin C with carotid intima-media thickness in community-living Taiwanese adults

BMC Nephrol. 2020 Oct 31;21(1):454. doi: 10.1186/s12882-020-02123-x.


Background: Renal function is a key factor of cardiovascular disease. Carotid intima-media thickness (IMT) has been widely used as a marker of early subclinical atherosclerosis. The determinants of cystatin C, a novel marker of renal function, have not been extensively studied in the Asian population. This study aimed to assess the determinants of cystatin C and explore whether carotid thickening was associated with urinary albumin-creatinine ratio and cystatin C in community-living Taiwanese adults.

Methods: A cross-sectional study was conducted on participants from Taichung City, Taiwan. All the participants underwent carotid ultrasonography. Carotid IMT-mean and IMT-maximum were derived. Kidney biomarkers were measured on the basis of urinary albumin-to-creatinine ratio (ACR) and cystatin C. Multiple linear regression analysis was used.

Results: A total of 1032 individuals were recruited, and 469 (45.44%) of them were men. An increased cystatin C level was significantly associated with older age, male gender, lack of physical activity, low HDL cholesterol, abdominal obesity, high hs-CRP, and high ACR. The multivariate-adjusted mean carotid IMT-mean and IMT-maximum values significantly increased by 80.49 and 195.23 μm for every one unit of increase in cystatin C level and by 0.07 and 0.14 μm for every one unit of increase in ACR, respectively (all p < 0.001 except ACR on IMT-maximum with p < 0.01). Lack of physical activity, low HDL, abdominal obesity, high hs-CRP, and high ACR were the determinants of cystatin C.

Conclusion: Cystatin C and ACR were strongly and linearly associated with carotid thickening, a marker of subclinical atherosclerosis.

Keywords: Albumin-to-creatinine ratio; Creatinine; Cystatin C; Intima-media thickness.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Albuminuria*
  • Atherosclerosis / blood
  • Atherosclerosis / diagnosis*
  • Atherosclerosis / urine
  • Biomarkers / blood
  • Carotid Arteries / diagnostic imaging
  • Carotid Intima-Media Thickness*
  • Creatinine / urine*
  • Cross-Sectional Studies
  • Cystatin C / blood*
  • Female
  • Heart Disease Risk Factors
  • Humans
  • Male
  • Middle Aged
  • Taiwan
  • Ultrasonography


  • Biomarkers
  • Cystatin C
  • Creatinine