Skeletal muscle mass (SM) was shown to be inversely related to cardiovascular disease (CVD) and mortality in some studies. However, the causal relationship between SM and CVD is not fully understood. Recently, creatinine-to-cystatin C ratio (Cr/cysC) has been suggested to be a useful surrogate marker for an estimation of SM. In the present study, we investigated whether Cr/cysC was related to intima-media thickness (IMT) in subjects with type 2 diabetes. A total of 459 patients with type 2 diabetes were recruited. Serum Cr and cysC were measured. All subjects were divided into three groups by gender-specific tertiles of Cr/cysC. We assessed carotid IMT using B-mode ultrasound. High IMT was defined as ≥ 75 percentiles of gender-specific maximal IMT. We checked body compositions using dual-energy X-ray absorptiometry. Patients with the highest tertile of Cr/cysC were younger and had higher prevalence of current smoking and regular exercise (RE) compared with those with the lowest. Also, they had higher values of Cr, fasting glucose (FG), HOMA-IR, and appendicular SM (ASM)/BMI, but had lower values of waist circumference (WC), cysC, Cr-based estimated glomerular filtration rate (Cr-eGFR), and IMT than those with the lowest. In the Pearson correlation, Cr/cysC was negatively related to age, BMI, and Cr-eGFR, but showed positive associations with FG and ASM/BMI in both genders. While WC and body fat percent were negatively associated with Cr/cysC in women alone. The odd ratios (ORs) for high IMT after adjusted for age were 0.76 (95% CI, 0.46-1.27) in the middle and 0.45 (95% CI, 0.25-0.79) in the highest, respectively. The OR in the highest was maintained significant after further adjustments for hypertension, current smoking, RE, BMI, WC, blood pressure, HDL, triglyceride, C-reactive protein, FG, HOMA-IR, and Cr-eGFR.

In conclusion, the present study showed that higher Cr/cysC was significantly related to the protection of risk for high IMT independently of multiple metabolic risk factors.


J. Shin: None.

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