Cystatin C and carotid intima-media thickness in asymptomatic adults: the Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND: Persons with early kidney disease have an increased risk of cardiovascular events and mortality, but the importance of accelerated atherosclerosis in promoting these outcomes is unclear. We therefore explored whether serum cystatin C level is associated with carotid intima-media thickness (IMT) in ambulatory adults without clinical heart disease. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: We evaluated 6,557 ethnically diverse persons free of clinical cardiovascular disease aged 45 to 84 years at the baseline visit of the Multi-Ethnic Study of Atherosclerosis. PREDICTORS: Kidney function was estimated by using 2 methods: serum cystatin C level and estimated glomerular filtration rate, based on creatinine and cystatin C levels. OUTCOMES & MEASUREMENTS: Study outcomes were internal and common carotid IMT, measured by using high-resolution B-mode ultrasound. Multivariate linear and logistic regressions were used to evaluate the independent association of kidney function with carotid IMT. RESULTS: In unadjusted linear analysis, each SD (0.23 mg/L) greater cystatin C level was associated with 0.091-mm greater internal carotid IMT (P < 0.001), but this association was diminished by 70% after adjustment for age, sex, and race/ethnicity (0.027 mm; P < 0.001) and was no longer significant after adjustment for cardiovascular risk factors (0.005 mm; P = 0.5). Similarly, the strong unadjusted associations of cystatin C level with common carotid IMT disappeared after adjustment. Chronic kidney disease, defined by using either creatinine level or cystatin C-based estimated glomerular filtration rate less than 60 mL/min/1.73 m(2), had no independent association with internal and common carotid IMT. LIMITATIONS: There were few participants with severe kidney disease. CONCLUSIONS: Cystatin C level had no independent association with carotid IMT in a population free of clinical heart disease. This observation suggests that accelerated atherosclerosis is unlikely to be the primary mechanism explaining the independent association of cystatin C level with cardiovascular risk.     

Density and Fat Fraction of the Psoas,Paraspinal, and Oblique Muscle Groups Are Associated With Lumbar Vertebral Bone Mineral Density in a Multi-Ethnic Community-Living Population: The Multi-Ethnic Study of Atherosclerosis

Low vertebral bone mass is a major risk factor for vertebral compression fractures. Although sarcopenia has been shown to be associated with low bone mineral density (BMD), it is not known whether trunk musculature is directly associated with lumbar BMD, and whether exercise modifies this association. Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we sought to determine the association of muscle density and fat fraction of the psoas, paraspinal, and oblique muscle groups with L₃ lumbar volumetric BMD, and whether these associations were modified by exercise. We obtained L₃ vBMD measurements, and fat and muscle measurements (in Hounsfield units [HU]) from abdominal computed tomography (CT) scans spanning the L₂–L₄ intervertebral disc spaces. Muscle density was defined as the mean HU value for a muscle group area. Fat fraction was calculated as the mean HU value for the muscle group fat area/total muscle group area (cm²). Exercise data were self-reported (MET-minute/week). We utilized multivariable linear regression to evaluate these associations, stratified by gender, and adjusting for demographics, body mass index (BMI), smoking status, impaired fasting glucose, and corticosteroid and anti-resorptive medication use. Among 1923 MESA participants, mean ± standard deviation (SD) age was 62 ± 10 years, 49% were female, 40% white, 21% black, 26% Hispanic/Latino, and 13% Chinese. In fully adjusted analysis, for every 1-SD higher psoas fat fraction, there was a 3.19-SD lower L₃ vBMD in men and 4.3-SD lower L₃ vBMD in women (p < 0.001). For every 1-SD higher psoas density, there was a 0.2-SD higher L₃ vBMD (p < 0.001) in men and 0.19-SD higher L₃ vBMD (p < 0.001) in women. Findings were similar for paraspinal and oblique muscles. Intentional exercise did not modify these associations. In men and women, trunk muscle density was positively associated with higher lumbar BMD, suggesting a local association. Future studies are warranted to determine the temporality of this association. © 2022 American Society for Bone and Mineral Research (ASBMR).     

Variation of the cervical spinal Torg ratio with gender and ethnicity.

BACKGROUND CONTEXT: The Torg ratio is used as a universal indicator of cervical canal stenosis despite reports of differences between gender and race. Normal values of this ratio have been established for subjects of different ethnicity, but the differences between genders and race have not been critically compared. PURPOSE: To establish normal cervical spinal dimensions and analyze the differences observed between men and women, and between reports using subjects of different ethnicity. STUDY DESIGN/SETTING: Observational. PATIENT SAMPLE: Forty men and 40 women of Chinese descent with no history or symptoms of neck pathology selected from patients presenting to the Emergency Department for foreign body ingestion. OUTCOME MEASURES: Measurements of the sagittal developmental diameter (SDD) and vertebral body diameter (VB) on the lateral cervical radiograph with calculation of SDD/VB (Torg ratio). METHODS: Lateral radiographs of the cervical spine were taken in a standardized manner with a 180-cm film-to-tube distance. Comparison was made between genders in the study population and with previous reports on subjects of different ethnicity. RESULTS: The SDD was narrowest at the C4 level in both men and women. Women had smaller SDDs at all levels of the cervical spine. Female VBs were of sizes similar to their corresponding SDDs, whereas men had larger VBs. This resulted in small Torg ratios in men averaging 0.87. Comparison with previous reports demonstrated consistent variation in the SDD, which increased serially from Japanese, through Chinese and Indian, to white subjects. The relationship of VB to the corresponding SDD displayed wide variation between reports. This resulted in Torg ratios differing not only between subjects of different ethnicity but also between genders within the same population. CONCLUSIONS: The Torg ratio is not a consistent indicator of the SDD and may not be used to reliably identify the presence of cervical canal stenosis.     

Compliance of the bladder: an attempt to establish normal values.

A study of 100 normal cystometries was undertaken to establish compliance values. The results seem to discourage the practical application of this parameter due to the absence of normal distribution and extreme scatter of values.     

Close correlation between the ankle-brachial index and symptoms of depression in hemodialysis patients

International Urology and Nephrology - As both of peripheral arterial disease (PAD) and depression carried a poor prognosis in patients on maintenance hemodialysis (MHD), we investigated the...