ELEVATED CYSTATIN-C CONCENTRATION AND PROGRESSION TO PREDIABETES: THE WESTERN NEW YORK STUDY

Abstract

OBJECTIVE -- We conducted a nested case-control investigation to examine if elevated baseline concentrations of cystatin-C predicted progression from normoglycmia to prediabetes over 6 years of follow-up from the Western New York Health Study.

RESEARCH DESIGN AND METHODS -- 1,455 participants from the Western New York Health Study, free of type 2 diabetes and known cardiovascular disease at baseline (1996-2001), were reexamined in 2002-2004. An incident case of prediabetes was defined as one with fasting glucose below 100 mg/dl at the baseline examination and ≥ 100 mg/dl and ≤ 125 mg/dl at the follow-up examination thereby eliminating prevalent prediabetic persons. All cases (n=91) were matched 1:3 to control participants based upon sex, race/ethnicity and year of study enrollment. All controls had fasting glucose levels < 100 mg/dl at both baseline and follow-up examinations. Cystatin-C concentrations and the urinary albumin to creatinine ratio were measured from frozen (-196 C°) baseline blood and urine samples. Serum creatinine concentrations were available from the baseline examination only.

RESULTS -- Multivariate conditional logistic regression analyses adjusted for age, baseline glucose level, HOMA-IR, body mass index, hypertension, eGFR, cigarette smoking, and alcohol use revealed a significantly increased risk of progression to prediabetes among those with elevated baseline concentrations of cystatin-C (Odds Ratio, 95% CI: 3.28, 1.43, 7.54) (upper quintile vs. the remainder). Results of secondary analyses that considered hs-CRP, IL-6, E-selectin, or sICAM did not alter these results.

CONCLUSIONS -- These results suggest that cystatin-C was associated with a three-fold excess risk of progression to prediabetes in this population.