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(Circulation. 2003;108:2317.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Inflammatory Markers and Onset of Cardiovascular Events

Results From the Health ABC Study

Matteo Cesari, MD; Brenda W.J.H. Penninx, PhD; Anne B. Newman, MD, MPH; Stephen B. Kritchevsky, PhD; Barbara J. Nicklas, PhD; Kim Sutton-Tyrrell, RN, DrPH; Susan M. Rubin, MPH; Jingzhong Ding, PhD; Eleanor M. Simonsick, PhD; Tamara B. Harris, MD, MS; Marco Pahor, MD

From the Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, NC (M.C., B.W.J.H.P., B.J.N., M.P.); University of Pittsburgh, Pittsburgh, Pa (A.B.N., K.S.-T.); University of Tennessee, Memphis (S.B.K.); University of California, San Francisco (S.M.R.); Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, Md (J.D., T.B.H.); and Intramural Research Program, National Institute on Aging, Baltimore, Md (E.M.S.).

Correspondence to Matteo Cesari, MD, Sticht Center on Aging, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157. E-mail mcesari{at}wfubmc.edu

Received April 7, 2003; de novo received July 14, 2003; revision received August 12, 2003; accepted August 14, 2003.

Background— Inflammation plays an important role in cardiovascular disease. The aim of this study is to investigate the predictive value of several inflammatory markers on the incidence of cardiovascular events in well-functioning older persons.

Methods and Results— The subjects were 2225 participants 70 to 79 years old, without baseline cardiovascular disease, who were enrolled in the Health, Aging, and Body Composition study. Incident coronary heart disease (CHD), stroke, and congestive heart failure (CHF) events were detected during an average follow-up of 3.6 years. Blood levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor- (TNF-) were assessed. After adjustment for potential confounders, IL-6 was significantly associated with all outcomes (CHD events, per IL-6 SD increase: RR, 1.27; 95% CI, 1.10 to 1.48; stroke events, per IL-6 SD increase: RR, 1.45; 95% CI, 1.12 to 1.86; CHF events, per IL-6 SD increase: RR, 1.72; 95% CI, 1.40 to 2.12). TNF- showed significant associations with CHD (per TNF- SD increase: RR, 1.22; 95% CI, 1.04 to 1.43) and CHF (per TNF- SD increase: RR, 1.59; 95% CI, 1.30 to 1.95) events. CRP was significantly associated with CHF events (per CRP SD increase: RR, 1.48; 95% CI, 1.23 to 1.78). A composite summary indicator of inflammation showed a strong association with incident cardiovascular events, with an especially high risk if all 3 inflammatory markers were in the highest tertile.

Conclusions— Findings suggest that inflammatory markers are independent predictors of cardiovascular events in older persons.

Key Words: cytokines • cardiovascular disease • inflammation

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				D. J. Campbell, M. Woodward, J. P. Chalmers, S. A. Colman, A. J. Jenkins, B. E. Kemp, B. C. Neal, A. Patel, and S. W. MacMahon Prediction of Heart Failure by Amino Terminal-pro-B-Type Natriuretic Peptide and C-Reactive Protein in Subjects With Cerebrovascular Disease Hypertension, January 1, 2005; 45(1): 69 - 74. [Abstract] [Full Text] [PDF]

				J. K. Pai, T. Pischon, J. Ma, J. E. Manson, S. E. Hankinson, K. Joshipura, G. C. Curhan, N. Rifai, C. C. Cannuscio, M. J. Stampfer, et al. Inflammatory Markers and the Risk of Coronary Heart Disease in Men and Women N. Engl. J. Med., December 16, 2004; 351(25): 2599 - 2610. [Abstract] [Full Text] [PDF]

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				R. A. Frost, G. J. Nystrom, and C. H. Lang Epinephrine stimulates IL-6 expression in skeletal muscle and C2C12 myoblasts: role of c-Jun NH2-terminal kinase and histone deacetylase activity Am J Physiol Endocrinol Metab, May 1, 2004; 286(5): E809 - E817. [Abstract] [Full Text] [PDF]

				L. Ibanez and F. de Zegher Ethinylestradiol-Drospirenone, Flutamide-Metformin, or Both for Adolescents and Women with Hyperinsulinemic Hyperandrogenism: Opposite Effects on Adipocytokines and Body Adiposity J. Clin. Endocrinol. Metab., April 1, 2004; 89(4): 1592 - 1597. [Abstract] [Full Text] [PDF]

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