Inflammatory markers and incident heart failure risk in older adults: the Health ABC (Health, Aging, and Body Composition) study.
OBJECTIVE
The purpose of this study was to evaluate the association between inflammation and heart failure (HF) risk in older adults.


BACKGROUND
Inflammation is associated with HF risk factors and also directly affects myocardial function.


METHODS
The association of baseline serum concentrations of interleukin (IL)-6, tumor necrosis factor-alpha, and C-reactive protein (CRP) with incident HF was assessed with Cox models among 2,610 older persons without prevalent HF enrolled in the Health ABC (Health, Aging, and Body Composition) study (age 73.6 +/- 2.9 years; 48.3% men; 59.6% white).


RESULTS
During follow-up (median 9.4 years), HF developed in 311 (11.9%) participants. In models controlling for clinical characteristics, ankle-arm index, and incident coronary heart disease, doubling of IL-6, tumor necrosis factor-alpha, and CRP concentrations was associated with 29% (95% confidence interval: 13% to 47%; p < 0.001), 46% (95% confidence interval: 17% to 84%; p = 0.001), and 9% (95% confidence interval: -1% to 24%; p = 0.087) increase in HF risk, respectively. In models including all 3 markers, IL-6, and tumor necrosis factor-alpha, but not CRP, remained significant. These associations were similar across sex and race and persisted in models accounting for death as a competing event. Post-HF ejection fraction was available in 239 (76.8%) cases; inflammatory markers had stronger association with HF with preserved ejection fraction. Repeat IL-6 and CRP determinations at 1-year follow-up did not provide incremental information. Addition of IL-6 to the clinical Health ABC HF model improved model discrimination (C index from 0.717 to 0.734; p = 0.001) and fit (decreased Bayes information criterion by 17.8; p < 0.001).


CONCLUSIONS
Inflammatory markers are associated with HF risk among older adults and may improve HF risk stratification.
Kalogeropoulos
Andreas
A
Emory University, Atlanta, Georgia, USA.
Georgiopoulou
Vasiliki
V
Psaty
Bruce M
BM
Rodondi
Nicolas
N
Smith
Andrew L
AL
Harrison
David G
DG
Liu
Yongmei
Y
Hoffmann
Udo
U
Bauer
Douglas C
DC
Newman
Anne B
AB
Kritchevsky
Stephen B
SB
Harris
Tamara B
TB
Butler
Javed
J
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein
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