title: Change in Leukocyte Telomere Length Predicts Mortality in Patients with Stable Coronary Heart Disease from the Heart and Soul Study.
abstract: BACKGROUND
  Short telomere length independently predicts mortality in patients with coronary heart disease. Whether 5-year change in telomere length predicts subsequent mortality in patients with coronary heart disease has not been evaluated.
  
  
  METHODS
  In a prospective cohort study of 608 individuals with stable coronary artery disease, we measured leukocyte telomere length at baseline and after five years of follow-up. We divided the sample into tertiles of telomere change: shortened, maintained or lengthened. We used Cox survival models to evaluate 5-year change in telomere length as a predictor of mortality.
  
  
  RESULTS
  During an average of 4.2 years follow-up, there were 149 deaths. Change in telomere length was inversely predictive of all-cause mortality. Using the continuous variable of telomere length change, each standard deviation (325 base pair) greater increase in telomere length was associated with a 24% reduction in mortality (HR 0.76, 95% CI 0.61-0.94; p = 0.01), adjusted for age, sex, waist to hip ratio, exercise capacity, LV ejection fraction, serum creatinine, and year 5 telomere length. Mortality occurred in 39% (79/203) of patients who experienced telomere shortening, 22% (45/203) of patients whose telomere length was maintained, and 12% (25/202) of patients who experienced telomere lengthening (p<0.001). As compared with patients whose telomere length was maintained, those who experienced telomere lengthening were 56% less likely to die (HR 0.44, 95% CI, 0.23-0.87).
  
  
  CONCLUSIONS
  In patients with coronary heart disease, an increase in leukocyte telomere length over 5 years is associated with decreased mortality.
authors: Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, United States of America.
authors: Sarah E
authors: SE
authors: Goglin
authors: Department of Psychiatry, University of California San Francisco, San Francisco, CA, 94143, United States of America.
authors: Ramin
authors: R
authors: Farzaneh-Far
authors: Department of Psychiatry, University of California San Francisco, San Francisco, CA, 94143, United States of America.
authors: Elissa S
authors: ES
authors: Epel
authors: Department of Biochemistry and Biophysics, UCSF, San Francisco, CA, 94143, United States of America.
authors: Jue
authors: J
authors: Lin
authors: Veterans Affairs Medical Center, San Francisco, CA, 94121, United States of America.
authors: Elizabeth H
authors: EH
authors: Blackburn
authors: Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, United States of America.|Veterans Affairs Medical Center, San Francisco, CA, 94121, United States of America.
authors: Mary A
authors: http://orcid.org/0000-0002-5943-0078
authors: MA
authors: Whooley
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality* / Q000523:psychology; D003404:Creatinine / Q000097:blood; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D053208:Kaplan-Meier Estimate; D007962:Leukocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012737:Sex Factors; D016615:Telomere / Q000378:metabolism*; D059506:Telomere Shortening; D016277:Ventricular Function, Left; D049629:Waist-Hip Ratio
chemical_list: D003404:Creatinine