title: Tumor necrosis factor receptor levels are associated with carotid atherosclerosis.
abstract: OBJECTIVE
  Recent evidence suggests that atherosclerosis is an inflammatory condition. Serum levels of inflammatory markers may serve as measures of the severity of atherosclerosis and risk of stroke. We sought to determine whether tumor necrosis factor-alpha (TNF-alpha) and TNF receptor levels are associated with carotid plaque thickness.
  
  
  METHODS
  The Northern Manhattan Stroke Study is a community-based study of stroke risk factors. For this cross-sectional analysis, inflammatory marker levels, including TNF-alpha and TNF receptors 1 and 2, were measured by immunoassay in stroke-free community subjects undergoing carotid duplex Doppler ultrasound. Maximal carotid plaque thickness (MCPT) was measured for each subject. Analyses were stratified by age < 70 and > or =70 years. Simple and multiple linear regression analyses were used to calculate the association between marker levels and MCPT. Multiple logistic regression was used to calculate odds ratios and 95% CIs for the association of inflammatory markers with MCPT > or =1.5 mm (>75th percentile), after adjustment for demographic and potential medical confounding factors.
  
  
  RESULTS
  The mean age of the 279 subjects was 67.6+/-8.5 years; 49% were men; 63% were Hispanic, 17% black, and 17% white. Mean values for TNF-alpha and its receptors were as follows: TNF-alpha, 1.88+/-3.97 ng/mL; TNF receptor 1, 2.21+/-0.99 ng/mL; and TNF receptor 2, 4.85+/-2.23 ng/mL. Mean MCPT was elevated in those in the highest quartiles compared with lowest quartiles of TNF receptor 1 and 2 (1.24 versus 0.79 mm and 1.23 versus 0.80 mm, respectively). Among those aged < 70 years, TNF receptor 1 and 2 were associated with an increase in MCPT (mean difference=0.36 mm, P=0.01 for TNF receptor 1 and mean difference=0.10 mm, P=0.04 for TNF receptor 2). After adjustment for sex, race-ethnicity, hypertension, diabetes mellitus, LDL cholesterol, smoking, and body mass index, associations remained (mean difference=0.36 mm, P=0.001 for TNF receptor 1 and mean difference=0.09 mm, P=0.051 for TNF receptor 2). There was no association for TNF receptors in those aged > or = 70 years old and no association for TNF-alpha in either age group. Among those aged < 70 years, each unit increase in TNF receptor level increased the odds of the participant's having MCPT > or =1.5 mm (adjusted odds ratio=4.7; 95% CI, 1.7 to 15.4 for TNF receptor 1; odds ratio=1.9; 95% CI, 1.3 to 2.9 for TNF receptor 2).
  
  
  CONCLUSIONS
  Relative elevation in TNF receptor levels, but not TNF-alpha, is associated with carotid atherosclerosis among individuals aged < 70 years in this multiethnic, urban population. Chronic subclinical infection or inflammation may account for this association, and modification of these inflammatory pathways may provide a novel approach to stroke prevention.
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Columbia-Presbyterian Medical Center of New York Presbyterian Hospital, New York, NY, USA. mse13@columbia.edu
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Elkind
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Cheng
authors.forename: Bernadette
authors.initials: B
authors.lastname: Boden-Albala
authors.forename: Tanja
authors.initials: T
authors.lastname: Rundek
authors.forename: Joyce
authors.initials: J
authors.lastname: Thomas
authors.forename: Hong
authors.initials: H
authors.lastname: Chen
authors.forename: LeRoy E
authors.initials: LE
authors.lastname: Rabbani
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000208:ethnology / Q000209:etiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018124:Receptors, Tumor Necrosis Factor / Q000032:analysis*; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D018616:Ultrasonography, Doppler, Duplex; D014504:Urban Health
chemical_list: D015415:Biomarkers; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha