Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk of a future first-ever myocardial infarction in women

Elisabet Söderström,Ravna Blind,Patrik Wennberg,Jonas Andersson,Stefan Söderberg,Torbjörn K Nilsson,Johan Hultdin

doi:10.1080/00365513.2021.1941235

Elisabet Söderström, Ravna Blind + Show 5 more

Open Access

https://doi.org/10.1080/00365513.2021.1941235

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Abstract

Impaired renal function is associated both with the development of cardiovascular disease and its prognosis. A new syndrome called ′Shrunken Pore Syndrome′ has been suggested, as the estimated glomerular filtration rate for cystatin C (eGFRcystatin C) is affected earlier due to differences in molecular size compared to eGFRcreatinine. The aim was to investigate if a lower eGFRcystatin C/eGFRcreatinine ratio in a prospective setting increases the risk of later developing a first-ever myocardial infarction (MI) independently of other cardiovascular risk factors. We used a nested case-referent study design within the Northern Sweden Health and Disease Study, and 545 subjects (29.0% women) were identified who prospectively developed a first-ever MI, and their 1054 matched referents. For women, but not for men, one standard deviation (SD) increase of ln z-scores of eGFRcystatin C/eGFRcreatinine ratio was associated with a lower risk of a future MI: odds ratio [95% confidence interval] 0.58 [0.34–0.99], adjusted for apolipoprotein B/A1 ratio, CRP, homocysteine, systolic blood pressure, body mass index, and diabetes. Furthermore, a high eGFRcreatinine associated independently with an increased risk of future MI in men only: OR 1.25 [1.05–1.48]. Thus, for women, a lower eGFRcystatin C/eGFRcreatinine ratio is associated with a higher risk of having a future first-ever MI, and it may be a valuable, easily implemented biomarker for risk of cardiovascular disease.

Highlights

Impaired renal function is a risk factor for cardiovascular disease (CVD) as well as for adverse outcomes for patients diagnosed with CVD [1,2]
In addition to conventional risk factors, biochemical biomarkers can be an essential addition to improving the prediction of myocardial infarction (MI) among patients with chronic kidney disease [20] and mild impaired renal function
We have previously found a prospective association between a first-ever MI and apolipoproteins A1 and B [14], CRP [21], and total plasma homocysteine [22] in our cohort

Summary

Introduction

Impaired renal function is a risk factor for cardiovascular disease (CVD) as well as for adverse outcomes for patients diagnosed with CVD [1,2]. In the early stage of impaired renal function, a GFR reduction is not seen, and Figure 1 depicts how this can be conceptualized This difference in sieving of biomarkers of different sizes depending on the type of kidney affection, quantitated by a ratio, eGFRcystatin C/eGFRcreatinine, is suggested as a more refined estimate of glomerular function, adding clinical and prognostic value [7,8,9]. It has been termed 0Shrunken Pore Syndrome0 (SPS). The definition of SPS was a cystatin C-based estimated glomerular filtration rate (eGFRcystatin C), being less than 60% of creatinine-based estimated glomerular filtration rate (eGFRcreatinine) [10]

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