title: Multiple inflammatory biomarkers in relation to cardiovascular events and mortality in the community.
abstract: OBJECTIVE
  Evidence suggests that chronic low-grade inflammation and oxidative stress are related to cardiovascular disease (CVD) and mortality.
  
  
  RESULTS
  We examined 11 established and novel biomarkers representing inflammation and oxidative stress (C-reactive protein, fibrinogen, interleukin-6, intercellular adhesion molecule-1, lipoprotein-associated phospholipase-A2 [mass and activity], monocyte chemoattractant protein-1, myeloperoxidase, CD40 ligand, P-selectin, and tumor necrosis factor receptor II [TNFRII]) in relation to incident major CVD and mortality in the community. We studied 3035 participants (mean age, 61 ± 9 years; 53% women). During follow-up (median, 8.9 years), 253 participants experienced a CVD event and 343 died. C-reactive protein (hazard ratio [HR] reported per SD ln-transformed biomarker, 1.18; 95% confidence interval [CI], 1.02-1.35; nominal P=0.02) and TNFRII (HR, 1.15; 95% CI, 1.01-1.32; nominal P=0.04) were retained in multivariable-adjusted models for major CVD, but were not significant after adjustment for multiple testing. The biomarkers related to mortality were TNFRII (HR, 1.33; 95% CI, 1.19-1.49; P<0.0001), ICAM-1 (HR, 1.24; 95% CI, 1.12-1.37; P<0.0001), and interleukin-6 (HR, 1.25; 95% CI, 1.12-1.39; P<0.0001). The addition of these markers to the model, including traditional risk factors, increased discrimination and reclassification for risk of death (P<0.0001), but not for CVD.
  
  
  CONCLUSIONS
  Of 11 inflammatory biomarkers tumor necrosis factor receptor II was related to cardiovascular disease and mortality in the Framingham Heart Study. The combination of TNFRII with C-reactive protein in relation to CVD and with interleukin-6 to mortality increased the predictive ability in addition to CVD risk factors for total mortality but not for incident CVD.
authors: Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA, USA.
authors: Renate B
authors: RB
authors: Schnabel
authors: Xiaoyan
authors: X
authors: Yin
authors: Martin G
authors: MG
authors: Larson
authors: Jennifer F
authors: JF
authors: Yamamoto
authors: João D
authors: JD
authors: Fontes
authors: Sekar
authors: S
authors: Kathiresan
authors: Jian
authors: J
authors: Rong
authors: Daniel
authors: D
authors: Levy
authors: John F
authors: JF
authors: Keaney
authors: Thomas J
authors: TJ
authors: Wang
authors: Joanne M
authors: JM
authors: Murabito
authors: Ramachandran S
authors: RS
authors: Vasan
authors: Emelia J
authors: EJ
authors: Benjamin
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000097:blood* / Q000401:mortality*; D018836:Inflammation Mediators / Q000097:blood*; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D025341:Principal Component Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; C573420:ICAM1 protein, human; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D047889:Receptors, Tumor Necrosis Factor, Type II; C415902:TNFRSF1B protein, human; D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein
keywords: cardiovascular disease; cohort; epidemiology; inflammation; mortality
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