Evaluation of the predictive ability of cystatin C and soluble Fas-receptor for the ischemic events development using a population-based biobank

Identification of individuals at high risk of atherosclerotic cardiovascular disease and premature death is essential for the development of primary prevention strategies. Objective. To evaluate the predictive value of cystatin C and soluble Fas receptor for ischemic events in the 35—69-year-old population. Materials and methods. Data from the cross-sectional study «Know Your Heart» (Arkhangelsk, Russia), performed in 2015—2017 (n=2370), the participants’ biomaterials bank, and prospective observation (median 7.5 years, n=2232) were used. Thirty-six endpoint cases (non-fatal myocardial infarction and death from coronary artery disease through September 2024) and 124 non-event controls were analyzed. Multivariate logistic regression analysis, adjusted for age, sex, and biomarker levels, was used. Results. High cystatin C (Q4) levels were associated with endpoint (ORa=5.29; 95% CI 1.48-18.93; p=0.010). However, when N-terminal brain natriuretic propeptide (N-t proBNP) (ln) and high-sensitivity C-reactive protein (hsCRP) (ln) were added to the model, this association lost statistical significance (ORa=3.30; 95%CI 0.87—12.47; p=0.079). In a case-control analysis, incorporation of the Fas receptor for apoptosis (sFas) to the model with two predictors (N-t proBNP, hsCRP) improved prediction value (ORa=4.19; 95% CI 1.05—16.76; p=0.042); comparison of the models (p=0.0415). The combination of sFas(ln), N-t proBNP(ln), and hsCRP(ln) demonstrated superior predictive value compared to cystatin C alone. Conclusion. Both immune-regulation biomarkers of apoptosis (cystatin C and soluble Fas receptor) have predictive value for adverse ischemic events, with soluble Fas receptor demonstrating independent predictive value in multivariate models.