title: Metabolic syndrome, inflammation, and incident heart failure in the elderly: the cardiovascular health study.
abstract: BACKGROUND
  Inflammation markers and metabolic syndrome (MetS) are associated with risk of congestive heart failure (CHF). We evaluated whether combining inflammation markers and MetS provided additive information for incident CHF and if incorporating inflammation markers to the MetS definition added prognostic information.
  
  
  RESULTS
  We studied 4017 men and women > or =65 years old, without baseline CHF or diabetes, participating in the Cardiovascular Health Study, an observational study with 12.2 years follow-up and 966 cases of incident CHF. Baseline "C-reactive protein (CRP)-MetS" or "interleukin (IL)-6-MetS" were defined as presence of 3 out of 6 components, with elevated CRP (> or =3 mg/L) or IL-6 (> or =2.21 pg/mL) as a sixth component added to ATPIII criteria. Cox models adjusted for CHF risk factors and incident coronary disease were used to calculate hazard ratios for CHF. MetS and elevated inflammation markers were independently associated with CHF risk (hazard ratios, 95% CI: 1.32, 1.16 to 1.51 for MetS; 1.53, 1.34 to 1.75 for CRP; 1.37, 1.19 to 1.55 for IL-6). There was a 20% relative excess risk attributed to the combination of MetS and CRP (95% CI, -44% to 88%). CRP-MetS and IL-6-MetS definitions reclassified 18% and 13%, respectively of participants as MetS. Both CRP-MetS and IL-6-MetS increased risk of CHF by 60% compared with those without MetS.
  
  
  CONCLUSIONS
  MetS and inflammation markers provided additive information on CHF risk in this elderly cohort. Inflammation-incorporated MetS definitions identified more participants with the same risk level as ATPIII MetS. Considering inflammation markers and MetS together may be useful in clinical and research settings.
authors.affiliation: Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Takeki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Nancy Swords
authors.initials: NS
authors.lastname: Jenny
authors.forename: Neil A
authors.initials: NA
authors.lastname: Zakai
authors.forename: Martin M
authors.initials: MM
authors.lastname: LeWinter
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Barzilay
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000097:blood* / Q000150:complications*; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D002097:C-Reactive Protein