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.

中文翻译：

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胱抑素 C 与血管和非血管死亡风险：一项针对老年男性的前瞻性队列研究。

目的 评估胱抑素 C（作为轻度至中度肾功能损害的标志物）与老年人血管和非血管死亡率的相关性。设计前瞻性队列研究。背景 1997 年至 1998 年对 1970 年白厅伦敦公务员研究中幸存者的重新调查。对象 5371 名男性（平均再调查年龄：77 岁）参加了再调查并测量了血浆胱抑素 C 浓度。主要结局指标随后 11 年（1997 年至 2008 年）的原因特异性死亡率。方法 在调整既往疾病和其他危险因素（包括终生血压）之前和之后，使用 Cox 回归来估计胱抑素 C 与血管和非血管死亡率的关联。结果 在 11.0 年的随访期内，有 1171 人死于血管原因 [每年每 1000 人中有 26 人 (py)]，有 1615 人死于非血管原因（每 1000 人中有 36 人）。与半胱氨酸蛋白酶抑制剂 C 在分布底部五分之一的男性相比，即使在调整了既往疾病和所有测量的混杂因素之后，前十名男性的血管和非血管死亡率（完全调整后的 P 均 <0.001）的死亡率高出约两倍，包括终生血压。血管死亡率每升高 50% 胱抑素 C 浓度的完全调整相对风险为 1.66 [95% CI 1.48 至 1.85]，缺血性心脏病死亡率为 1.92 [95% CI 1.66 至 2.22] 和 1.46 [95% CI 1.31 至 1.61]对于非血管死亡率。结论 在老年男性中，胱抑素 C 的血浆浓度可能是轻度肾病的标志物，