Inflammatory Markers and Incident Heart Failure Risk in Older Adults: The Health, Aging, and Body Composition Study

• Type of Material: Article
• Authors: Andreas Kalogeropoulos, Emory University; Vasiliki (Vicki) Georgiopoulou, Emory University; Bruce M. Psaty, University of Washington; Nicolas Rodondi, University of Lausanne; Andrew L Smith, Emory University; David G Harrison, Emory University; Yongmei Liu, Wake Forest University; Udo Hoffmann, Harvard; Douglas C. Bauer, University of California; Anne B. Newman, University of Pittsburgh; Stephen B. Kritchevsky, Wake Forest University; Tamara B. Harris, National Institutes of Health; Javed Butler, Emory University
• Language: English
• Date: 2010-05-11
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2009.12.045
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• ISSN: 0735-1097
• Volume: 55
• Issue: 19
• Start Page: 2129
• End Page: 2137
• Grant/Funding Information: Support for this research was also partially funded through an Emory University Heart and Vascular Board grant titled ‘Novel Risk Markers and Prognosis Determination in Heart Failure’.; This research was supported in part by the Intramural Research Program of the National Institute of Aging, National Institutes of Health, Bethesda, Maryland, and by grants N01-AG-6-2101, N01-AG-6-2103, and N01-AG-6-2106.
• Keywords: Elderly; Heart Failure; Inflammation
• Research Categories: Gerontology; Health Sciences, Medicine and Surgery

Abstract

Objectives 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-6 (IL-6), tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) with incident HF was assessed with Cox models among 2610 older persons without prevalent HF enrolled in the Health ABC Study (age, 73.6±2.9 years; 48.3% men; 59.6% white). Results During follow-up (median, 9.4 years), 311 participants (11.9%) developed HF. In models controlling for clinical characteristics, ankle-arm index, and incident coronary heart disease, doubling of IL-6, TNF-α, and CRP concentrations was associated with 29% (95% CI, 13 to 47%; P<.001), 46% (95% CI, 17 to 84%; P=.001), and 9% (95% CI, -1 to 24%; P=.087) increase in HF risk, respectively. In models including all three markers, IL-6 and TNF- α, 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=.001) and fit (decreased Bayes information criterion by 17.8; P<.001). Conclusions Inflammatory markers are associated with HF risk among older adults and may improve HF risk stratification.