title: Relations of a marker of endothelial activation (s-VCAM) to function and mortality in community-dwelling older adults.
abstract: BACKGROUND
  We wished to determine if a marker of endothelial dysfunction/activation soluble vascular cell adhesion molecule (s-VCAM)-was related to functional status and mortality in community-dwelling older adults independent of the known effects of markers of inflammation and coagulation.
  
  
  METHODS
  Data came from the third and fourth in-person waves of the Duke Established Populations for Epidemiologic Studies of the Elderly. Participants (aged ≥ 71 years) had participated in a blood draw (N = 1,551) from which concentrations of s-VCAM, interleukin-6, and D-dimer were determined. Information was gathered in-person on demographics, health behaviors, chronic health conditions, and functional status (Katz, Rosow-Breslau, Nagi). Death was determined through the National Death Index. Multivariable regression analysis was used to examine the adjusted association of s-VCAM with functional status; Cox proportional hazards models ascertained hazard of mortality.
  
  
  RESULTS
  Controlled analyses indicated that cross-sectionally, but not longitudinally (4 years later), greater s-VCAM concentrations were associated with poorer function as measured by the Katz and Rosow-Breslau scales (p < .05 for both), independent of interleukin-6 and D-dimer. In controlled analyses, s-VCAM (p = .002), D-dimer (p = .008), and interleukin-6 (p = .01) were independently related to 4-year mortality; 1 SD increase in log concentration conferred 1.2-, 1.1-, and 1.2-fold increases in mortality, respectively. The greatest hazard of mortality was observed within the first year after measurement. s-VCAM concentrations were not predictive of 15-year mortality.
  
  
  CONCLUSIONS
  Independent of inflammation and coagulation markers, endothelial dysfunction serves as a marker of, and potentially contributes causally to, poor function and death in community-dwelling older adults.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Affairs Medical Center, Durham, NC, USA. huffm007@mc.duke.edu
authors.forename: Kim M
authors.initials: KM
authors.lastname: Huffman
authors.forename: Carl F
authors.initials: CF
authors.lastname: Pieper
authors.forename: Virginia B
authors.initials: VB
authors.lastname: Kraus
authors.forename: William E
authors.initials: WE
authors.lastname: Kraus
authors.forename: Gerda G
authors.initials: GG
authors.lastname: Fillenbaum
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Cohen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000097:blood* / Q000502:physiology*; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000502:physiology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D012111:Residence Characteristics; D012995:Solubility; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood*
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C508600:IL6 protein, human; D015850:Interleukin-6; D019010:Vascular Cell Adhesion Molecule-1; C036309:fibrin fragment D