Relationship of High Circulating Cystatin C to Biochemical Markers of Bone Turnover and Bone Mineral Density in Elderly Males with a Chronic Heart Failure

The aim of the study was to investigate the association of Cystatin C (CysC) to biochemical markers of bone turnover and bone mass, and to evaluate its prognostic significance in elderly males with chronic heart failure (CHF).A prospective cohort study was executed on sixtyeight males (mean age 68±7 years) with mild to moderate CHF, together with 19 of corresponding age- and body mass index-matched healthy individuals who underwent cardio vascular, bone mineral density (BMD), and body com position assessment. Biochemical assessment of all subjects included NT-pro-BNP, parathyroid hormone (PTH), 25-hydroxy vitamin D (25(OH)D), CysC, and biochemical markers of bone turnover including osteocalcin (OC), alkaline phosphatase (ALP), β-CrossLaps (β-CTx), osteoprotegerin (OPG), and receptor activator of nuclear factor κB ligand (RANKL).Serum CysC was significantly increased in males with CHF in comparison to healthy control ones. A significant positive association was found between CysC levels and OC in males with CHF, while OC and β-CTx increased in increasing CysC tertiles. In multivariate regression analysis, OC and smoking were a significant determinant of CysC in males with CHF. Level of CysC was found to be positively associated with an increased fatal risk in males with CHF.Serum osteocalcin is an independent predictor of CysC level in elderly males with CHF. Higher CysC level showed a negative relation to survival and bone loss in males with CHF. Further research is needed to confirm the potential role of CysC in the crosstalk between heart, kidney, bone, and energy metabolism in CHF.Cilj studije je bio da se ispita povezanost cistatina C (CisC) i biohemijskih markera metabolizma kosti i mineralne koštane gustine, kao i da se proceni prognostički značaj CisC kod starijih muškaraca sa hroničnom srčanom insuficijencijom (HSI).Ovo istraživanje je prospektivna studija kohorte koju je činilo šezdeset osam muškaraca (prosečne starosti 68±7 godina života) sa blagom do umerenom HSI i 19 zdravih osoba odgovarajuće starosti i indeksa telesne mase. Svi ispitanici su podvrgnuti proceni kardiovaskularnog sistema, mineralne koštane gustine i telesnog sastava. Biohemijska merenja kod svih ispitanika su uključivala određivanje NT-pro-BNP, paratiroidnog hormona (PTH), 25-hidroksi vitamina D (25 (OH) D), CisC i biohemijskih markera metabolizma kosti, uključujući osteokalcin (OC), alkalnu fosfatazu (ALP), beta-CrossLaps (b-CTx), osteoprotegerin (OPG) i ligand za receptor aktivator nuklearnog faktora B (RANKL).Serumski CisC je značajno povećan u muškaraca sa HSI u poređenju sa nivoom kod zdravih osoba. Značajna pozitivna povezanost detektovana je između nivoa CisC i OC kod muškaraca sa HSI, i vrednosti OC i b-CTx su povećane kod pacijenata u rastućim CisC tercijarima. U multivarijantnoj regresionoj analizi je pokazano da su OC i pušenje znač ajne determinante nivoa CisC kod muškaraca sa HSI. Nivo CisC je u pozitivnoj korelaciji sa povećanim rizikom za mortalitet kod muškaraca sa HSI.Serumski osteokalcin je nezavisan prediktor nivoa CisC kod starijih muškaraca sa HSI. Povećan nivo CisC je pokazao negativnu povezanost sa preživljanjem i gubitkom kosti kod muškaraca sa HSI. Potrebno je da buduća istraživanja potvrde potencijalnu ulogu CisC u komunikaciji između srca, bubrega, kosti i energetskog metabolizma u hroničnoj srčanoj insuficijenciji.