Markers of atherosclerosis and inflammation for prediction of coronary heart disease in older adults.
Although both inflammatory and atherosclerosis markers have been associated with coronary heart disease (CHD) risk, data directly comparing their predictive value are limited. The authors compared the value of 2 atherosclerosis markers (ankle-arm index (AAI) and aortic pulse wave velocity (aPWV)) and 3 inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha)) in predicting CHD events. Among 2,191 adults aged 70-79 years at baseline (1997-1998) from the Health, Aging, and Body Composition Study cohort, the authors examined adjudicated incident myocardial infarction or CHD death ("hard" events) and "hard" events plus hospitalization for angina or coronary revascularization (total CHD events). During 8 years of follow-up between 1997-1998 and June 2007, 351 participants developed total CHD events (197 "hard" events). IL-6 (highest quartile vs. lowest: hazard ratio = 1.82, 95% confidence interval: 1.33, 2.49; P-trend < 0.001) and AAI (AAI < or = 0.9 vs. AAI 1.01-1.30: hazard ratio = 1.57, 95% confidence interval: 1.14, 2.18) predicted CHD events above traditional risk factors and modestly improved global measures of predictive accuracy. CRP, TNF-alpha, and aPWV had weaker associations. IL-6 and AAI accurately reclassified 6.6% and 3.3% of participants, respectively (P's < or = 0.05). Results were similar for "hard" CHD, with higher reclassification rates for AAI. IL-6 and AAI are associated with future CHD events beyond traditional risk factors and modestly improve risk prediction in older adults.
Rodondi
Nicolas
N
Department of Ambulatory Care and Community Medicine, Faculty of Biology and Medicine, University of Lausanne, 1011Lausanne, Switzerland. nicolas.rodondi@hospvd.ch
Marques-Vidal
Pedro
P
Butler
Javed
J
Sutton-Tyrrell
Kim
K
Cornuz
Jacques
J
Satterfield
Suzanne
S
Harris
Tamara
T
Bauer
Douglas C
DC
Ferrucci
Luigi
L
Vittinghoff
Eric
E
Newman
Anne B
AB
D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000378:metabolism*; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein