title: Simple indices of inflammation as predictors of death from cancer or cardiovascular disease in a prospective cohort after two decades of follow-up.
abstract: BACKGROUND
  Previous studies have identified sub-clinical inflammation as a potential factor in the pathogenesis of cancer and cardiovascular disease (CVD) but the possibility that simple, readily measured indices of sub-clinical inflammation might predict both CVD and cancer has not been tested in the context of a single, prospective analysis.
  
  
  OBJECTIVE
  To evaluate simply measured indices of inflammation as long-term predictors of death from either cancer or CVD.
  
  
  METHODS
  Prospective open cohort study.
  
  
  METHODS
  A total of 1192 white males received measurements of a range of risk markers including the inflammation indices white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and serum globulin concentrations. Inflammation marker clustering was quantified as a factor-analysis-derived inflammation score and survival time to death from any cancer or CVD was modeled on baseline measures using the Cox proportional hazards model.
  
  
  RESULTS
  A total of 1010 participants met inclusion criteria, of whom 94 died of cancer and 67 of CVD. Mean follow-up times among cases and survivors ranged from 18.2-21.9 years. Independently of established risk factors [age, body mass index (BMI), smoking, alcohol and exercise], WBC, ESR and globulin levels were all individually predictive of both cancer (hazard ratio 1.43, P = 0.002; 1.27, P = 0.02; 1.26, P = 0.02, respectively) and CVD mortality (1.29, P = 0.06; 1.43, P = 0.007; 1.50, P = 0.001). The inflammation score predicted both cancer mortality (1.35, P = 0.003) and CVD mortality (1.46, P = 0.002). Risks associated with high inflammation score were equivalent to and independent of smoking cigarettes for cancer or, for CVD, having a serum cholesterol concentration ≥6.2 mmol/l.
  
  
  CONCLUSIONS
  Simple indices of inflammation predict death from cancer or CVD two decades later as strongly as smoking predicts cancer or cholesterol predicts CVD. Their measurement could contribute to evaluation of both cancer and CVD risk.
authors.affiliation: Endocrinology and Metabolic Medicine, Imperial College London, St Mary's Campus, Mint Wing, Praed Street, London W2 1PG, UK. i.godsland@imperial.ac.uk
authors.forename: I F
authors.initials: IF
authors.lastname: Godsland
authors.forename: B V
authors.initials: BV
authors.lastname: North
authors.forename: D G
authors.initials: DG
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001799:Blood Sedimentation; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D004812:Epidemiologic Methods; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000401:mortality*; D012307:Risk Factors
chemical_list: D015415:Biomarkers