A cross-sectional and longitudinal cohort study of creatinine-to-cystatin C ratio and cardiovascular disease risk in a middle-aged and elderly population

BackgroundThe creatinine-to-cystatin C ratio (CCR) has recently been proposed as a proxy indicator for sarcopenia. It has been linked to a range of adverse outcomes. However, the relationship between the CCR and cardiovascular disease (CVD) is not widely recognized. This study used data from the Chi...

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Main Authors: Yuling Chen, Fengmin Xu, Jia Li, Yixi Bao
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Frontiers in Endocrinology
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Online Access:https://www.frontiersin.org/articles/10.3389/fendo.2025.1531394/full
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author Yuling Chen
Yuling Chen
Fengmin Xu
Jia Li
Yixi Bao
author_facet Yuling Chen
Yuling Chen
Fengmin Xu
Jia Li
Yixi Bao
author_sort Yuling Chen
collection DOAJ
description BackgroundThe creatinine-to-cystatin C ratio (CCR) has recently been proposed as a proxy indicator for sarcopenia. It has been linked to a range of adverse outcomes. However, the relationship between the CCR and cardiovascular disease (CVD) is not widely recognized. This study used data from the China Health and Retirement Longitudinal Study to investigate the association between the CCR and CVD in a middle-aged and elderly population.MethodsThe cross-sectional study and longitudinal cohort study included 10,614 and 6,720 passengers, respectively. The occurrence of CVD incidents was defined as self-reported health history or receipt of cardiac disease treatment. The CCR through creatinine (mg/dL) and cystatin C (mg/dL) were calculated and grouped by quartiles. Unadjusted and adjusted logistic regression models were employed to further explore the CCR-CVD relationships.ResultsThe findings of our study demonstrated a progressively significant reduction in the risk of CVD with an additional CCR. The cross-sectional cohort findings indicated a 21% reduction in the risk of CVD with every additional unit of CCR (OR=0.79, 95% CI, 0.73-0.84). In three logistic regression models, there was a significant association between CCR quartiles and a lower risk of CCR (p for trend <0.001). Further subgroup analyses revealed a 16% reduction in the incidence of CVD with each additional unit of CCR among individuals aged below 65 years (OR, 0.84; 95% CI, 0.78–0.91) and a 18% decline in CVD with each unit of CCR in married populations (OR, 0.82; 95% CI, 0.77–0.88). The findings of the Longitudinal Cohort Study indicated that for each unit increase in CCR, there was an 22% reduction in the risk of CVD (OR=0.78, 95% CI, 0.68-0.90). In logistic regression models adjusted for all co-dependent variables, the prevalence of CVD was reduced by 15%, 21%, and 41% as the number of CCR quartiles increased. This result was also verified by restricted cubic spline analysis.ConclusionIn conclusion, the correlation between an elevated CCR and a reduced risk of CVD in middle-aged and elderly populations has been established. Enhanced CCR levels may prove useful in predicting CVD occurrence in the elderly, thus representing a simple and effective biomarker.
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spelling doaj-art-82e4cd99006142fd9555770dde4b59f42025-08-20T02:30:03ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-05-011610.3389/fendo.2025.15313941531394A cross-sectional and longitudinal cohort study of creatinine-to-cystatin C ratio and cardiovascular disease risk in a middle-aged and elderly populationYuling Chen0Yuling Chen1Fengmin Xu2Jia Li3Yixi Bao4Department of Clinical Laboratory, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Clinical Laboratory, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, ChinaDepartment of Clinical Laboratory, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, ChinaDepartment of Clinical Laboratory, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, ChinaDepartment of Clinical Laboratory, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaBackgroundThe creatinine-to-cystatin C ratio (CCR) has recently been proposed as a proxy indicator for sarcopenia. It has been linked to a range of adverse outcomes. However, the relationship between the CCR and cardiovascular disease (CVD) is not widely recognized. This study used data from the China Health and Retirement Longitudinal Study to investigate the association between the CCR and CVD in a middle-aged and elderly population.MethodsThe cross-sectional study and longitudinal cohort study included 10,614 and 6,720 passengers, respectively. The occurrence of CVD incidents was defined as self-reported health history or receipt of cardiac disease treatment. The CCR through creatinine (mg/dL) and cystatin C (mg/dL) were calculated and grouped by quartiles. Unadjusted and adjusted logistic regression models were employed to further explore the CCR-CVD relationships.ResultsThe findings of our study demonstrated a progressively significant reduction in the risk of CVD with an additional CCR. The cross-sectional cohort findings indicated a 21% reduction in the risk of CVD with every additional unit of CCR (OR=0.79, 95% CI, 0.73-0.84). In three logistic regression models, there was a significant association between CCR quartiles and a lower risk of CCR (p for trend <0.001). Further subgroup analyses revealed a 16% reduction in the incidence of CVD with each additional unit of CCR among individuals aged below 65 years (OR, 0.84; 95% CI, 0.78–0.91) and a 18% decline in CVD with each unit of CCR in married populations (OR, 0.82; 95% CI, 0.77–0.88). The findings of the Longitudinal Cohort Study indicated that for each unit increase in CCR, there was an 22% reduction in the risk of CVD (OR=0.78, 95% CI, 0.68-0.90). In logistic regression models adjusted for all co-dependent variables, the prevalence of CVD was reduced by 15%, 21%, and 41% as the number of CCR quartiles increased. This result was also verified by restricted cubic spline analysis.ConclusionIn conclusion, the correlation between an elevated CCR and a reduced risk of CVD in middle-aged and elderly populations has been established. Enhanced CCR levels may prove useful in predicting CVD occurrence in the elderly, thus representing a simple and effective biomarker.https://www.frontiersin.org/articles/10.3389/fendo.2025.1531394/fullcreatininecystatin Ccardiovascular diseaseolder adultsCCR
spellingShingle Yuling Chen
Yuling Chen
Fengmin Xu
Jia Li
Yixi Bao
A cross-sectional and longitudinal cohort study of creatinine-to-cystatin C ratio and cardiovascular disease risk in a middle-aged and elderly population
Frontiers in Endocrinology
creatinine
cystatin C
cardiovascular disease
older adults
CCR
title A cross-sectional and longitudinal cohort study of creatinine-to-cystatin C ratio and cardiovascular disease risk in a middle-aged and elderly population
title_full A cross-sectional and longitudinal cohort study of creatinine-to-cystatin C ratio and cardiovascular disease risk in a middle-aged and elderly population
title_fullStr A cross-sectional and longitudinal cohort study of creatinine-to-cystatin C ratio and cardiovascular disease risk in a middle-aged and elderly population
title_full_unstemmed A cross-sectional and longitudinal cohort study of creatinine-to-cystatin C ratio and cardiovascular disease risk in a middle-aged and elderly population
title_short A cross-sectional and longitudinal cohort study of creatinine-to-cystatin C ratio and cardiovascular disease risk in a middle-aged and elderly population
title_sort cross sectional and longitudinal cohort study of creatinine to cystatin c ratio and cardiovascular disease risk in a middle aged and elderly population
topic creatinine
cystatin C
cardiovascular disease
older adults
CCR
url https://www.frontiersin.org/articles/10.3389/fendo.2025.1531394/full
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