{"id":"41f42835f498","type":"article","url":"https://hartvaat.nl/2026/11/01/cystatine-c-voorspelt-hart-en-nierrisico-beter-dan-creatinine-bij-diabetes-type-/","title":"Cystatine C voorspelt hart- en nierrisico beter dan creatinine bij diabetes type 2 — DECLARE-TIMI 58","title_en":"Comparative risk assessment of cardiovascular and kidney outcomes in patients with type 2 diabetes using cystatin C and creatinine in DECLARE-TIMI 58.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"American heart journal plus : cardiology research and practice","doi":"10.1016/j.ahjo.2026.100929","source_url":"https://doi.org/10.1016/j.ahjo.2026.100929","authors":["Andre M Small","David D Berg","Itamar Raz","Petr Jarolim","Erica L Goodrich","Filipe A Moura","Ofri Mosenzon","Avivit Cahn","Deepak L Bhatt","Jamie P Dwyer","Lawrence A Leiter","John P H Wilding","Ingrid Gause-Nilsson","Marc S Sabatine","David A Morrow","Stephen D Wiviott"],"significance":4,"published":"2026-11-04","source_date":"2026-11-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/polypil-cardiovasculair/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"In a nested biomarker analysis of the DECLARE-TIMI 58 trial, cystatin C demonstrated a stronger risk gradient for cardiovascular and kidney outcomes than creatinine in patients with type 2 diabetes and preserved kidney function. Patients in the highest quartile had a 33% higher risk of cardiovascular death or heart failure hospitalization (HR 1.33; p-trend 0.016) compared with the lowest quartile, whereas creatinine-based stratification showed no significant gradient. The cardiovascular and renal benefit of dapagliflozin was consistent regardless of baseline cystatin C levels, supporting its broad use in this population.","created":"2026-10-28T02:41:32Z","updated":"2026-10-28T02:41:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een nested analyse van de DECLARE-TIMI 58-studie bleek cystatine C een sterker risicogradient te geven voor cardiovasculaire en niercomplicaties dan creatinine bij patiënten met diabetes type 2 en een behouden nierfunctie. Patiënten in het hoogste quartiel hadden een 33% hoger risico op hartfalenhospitalisatie of cardiovasculaire dood (HR 1,33; p-trend 0,016) vergeleken met het laagste quartiel, terwijl creatinine geen significante gradient toonde. Het preventieve effect van dapagliflozin bleek onafhankelijk van de baselijn-cystatine C-waarde, wat ondersteunt dat deze SGLT2-remmer breed inzetbaar blijft in deze patiëntengroep.","abstract_original":"BACKGROUND: The relationship between cystatin C and cardiovascular and kidney outcomes is not well explored in individuals with type 2 diabetes (T2D) and normal or mild kidney dysfunction. METHODS: This nested prospective biomarker study included patients enrolled in DECLARE-TIMI 58. Participants were categorized into quartiles of CysC/creatinine and eGFRCysC/eGFRCr and classified according to Kidney Disease Improving Global Outcomes (KDIGO) risk categories. Hazard ratios were estimated for a composite of cardiovascular death and hospitalization for heart failure (CVD/HHF), major adverse cardiovascular events (MACE), and a kidney-specific composite outcome (persistent ≥40% decrease in eGFR, end-stage renal disease, or renal death). RESULTS: Among 1899 placebo-treated patients, higher baseline CysC was associated with higher risk for CVD/HHF, MACE, and the kidney-specific composite outcome. A gradient of risk across quartiles was observed for CVD/HHF [Q4 v Q1: 1.33 (0.98-1.80), p-trend = 0.016]; MACE [1.34 (1.06-1.69), p-trend = 0.013]; and kidney-specific composite outcome [1.95 (0.95-3.99), p-trend = 0.036]. When compared with creatinine, CysC showed more pronounced and statistically significant risk gradients (CVD/HHF: KDIGO-CysC p-trend < 0.001 vs. p-trend Cr 0.34; MACE: CysC p-trend < 0.001 vs. Cr p-trend 0.52). No heterogeneity was observed in the effect of dapagliflozin across CysC concentrations (p-interactions >0.05). CONCLUSION: In patients with T2D and predominantly preserved Cr-based eGFR, CysC was associated with increased cardiovascular and kidney risk. Although discrimination assessed by c-statistic was similar for CysC and Cr, risk gradients seen with CysC became attenuated and no longer statistically significant when using Cr-based analogs. The effect of dapagliflozin was consistent irrespective of baseline CysC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01730534."}