Association of albumin-creatinine ratio and cystatin C with change in ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA) Journal Article

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Authors: Garimella, P. S.; Ix, J. H.; Katz, R; Shlipak, M. G.; Criqui, M. H.; Siscovick, D. S.; Kramer, H; Sibley, C. T.; Sarnak, M. J.
Article Title: Association of albumin-creatinine ratio and cystatin C with change in ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA)
Abstract: BACKGROUND: Low ankle-brachial index (ABI) is a reflection of atherosclerotic disease, and high ABI is an indicator of calcified vessels. The associations of albuminuria and cystatin C level with incidence of either low or high ABI are unknown. STUDY DESIGN: Prospective longitudinal cohort study. SETTING PARTICIPANTS: MESA (Multi-Ethnic Study of Atherosclerosis) enrolled community-dwelling adults (N=6,814) aged 45-84 years who were free of clinical cardiovascular disease at baseline. PREDICTORS: Baseline albumin-creatinine ratio (ACR) and serum cystatin C level. OUTCOMES: Development of low (1.40) ABI using multinomial regression among persons with ABI of 0.90-1.40 at baseline. RESULTS: During 9.8 years of follow-up, 221 and 89 participants progressed to low and high ABIs, respectively. Baseline ACR and cystatin C level were higher among progressors compared with nonprogressors. In multivariable analyses, doubling of ACR was associated with increased risk of progression to low (OR, 1.08; 95% CI, 0.99-1.20) and high (OR, 1.16; 95% CI, 1.01-1.32) ABIs. Compared to the lowest quintile, the highest quintile of ACR had a significantly increased risk of progression to low (OR, 1.79; 95% CI, 1.03-3.12) and high (OR, 2.76; 95% CI, 1.32-5.77) ABIs. Higher cystatin C levels were associated with progression to low (OR per 1-SD greater, 1.12; 95% CI, 1.00-1.26) but not high (OR per 1-SD greater, 1.01; 95% CI, 0.81-1.25) ABI, but the highest quintile of cystatin C was not associated independently with either outcome. LIMITATIONS: Single measure of albuminuria and low number of progressors to high ABI. CONCLUSIONS: In adults free of clinical cardiovascular disease, albuminuria was a strong independent risk factor for the development of both high and low ABIs, important and different measures of peripheral artery disease.
Journal Title: American Journal of Kidney Diseases : The Official Journal of the National Kidney Foundation
Volume: 65
Issue: 1
ISSN: 1523-6838; 0272-6386
Publisher: Elsevier Inc  
Journal Place: United States
Date Published: 2015
Start Page: 33
End Page: 40
Language: eng
DOI/URL:

10.1053/j.ajkd.2014.05.014
Notes: LR: 20150401; CI: Copyright (c) 2014; GR: K24 DK078204/DK/NIDDK NIH HHS/United States; GR: K24 DK078204/DK/NIDDK NIH HHS/United States; GR: N01/HL/NHLBI NIH HHS/United States; GR: N01-HC-95159/HC/NHLBI NIH HHS/United States; GR: N01-HC-95159/HL/NHLBI NIH HHS/United States; GR: N01-HC-95160/HC/NHLBI NIH HHS/United States; GR: N01-HC-95160/HL/NHLBI NIH HHS/United States; GR: N01-HC-95161/HC/NHLBI NIH HHS/United States; GR: N01-HC-95162/HC/NHLBI NIH HHS/United States; GR: N01-HC-95163/HC/NHLBI NIH HHS/United States; GR: N01-HC-95164/HC/NHLBI NIH HHS/United States; GR: N01-HC-95165/HC/NHLBI NIH HHS/United States; GR: N01-HC-95166/HC/NHLBI NIH HHS/United States; GR: N01-HC-95167/HC/NHLBI NIH HHS/United States; GR: N01-HC-95168/HC/NHLBI NIH HHS/United States; GR: N01-HC-95169/HC/NHLBI NIH HHS/United States; GR: UL1-RR-025005/RR/NCRR NIH HHS/United States; GR: UL1-TR-000040/TR/NCATS NIH HHS/United States; JID: 8110075; 0 (Cystatin C); AYI8EX34EU (Creatinine); NIHMS612533; OID: NLM: NIHMS612533 [Available on 01/01/16]; OID: NLM: PMC4272615 [Available on 01/01/16]; OTO: NOTNLM; PMCR: 2016/01/01 00:00; 2014/02/20 [received]; 2014/05/13 [accepted]; 2014/07/03 [aheadofprint]; ppublish