Markers of Atherosclerosis and Inflammation for Prediction of Coronary Heart Disease in Older Adults

Department of Ambulatory Care and Community Medicine, Faculty of Biology and Medicine, University of Lausanne, 1011Lausanne, Switzerland.
American journal of epidemiology (Impact Factor: 5.23). 03/2010; 171(5):540-9. DOI: 10.1093/aje/kwp428
Source: PubMed


Although both inflammatory and atherosclerosis markers have been associated with coronary heart disease (CHD) risk, data directly comparing their predictive value are limited. The authors compared the value of 2 atherosclerosis markers (ankle-arm index (AAI) and aortic pulse wave velocity (aPWV)) and 3 inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha)) in predicting CHD events. Among 2,191 adults aged 70-79 years at baseline (1997-1998) from the Health, Aging, and Body Composition Study cohort, the authors examined adjudicated incident myocardial infarction or CHD death ("hard" events) and "hard" events plus hospitalization for angina or coronary revascularization (total CHD events). During 8 years of follow-up between 1997-1998 and June 2007, 351 participants developed total CHD events (197 "hard" events). IL-6 (highest quartile vs. lowest: hazard ratio = 1.82, 95% confidence interval: 1.33, 2.49; P-trend < 0.001) and AAI (AAI < or = 0.9 vs. AAI 1.01-1.30: hazard ratio = 1.57, 95% confidence interval: 1.14, 2.18) predicted CHD events above traditional risk factors and modestly improved global measures of predictive accuracy. CRP, TNF-alpha, and aPWV had weaker associations. IL-6 and AAI accurately reclassified 6.6% and 3.3% of participants, respectively (P's < or = 0.05). Results were similar for "hard" CHD, with higher reclassification rates for AAI. IL-6 and AAI are associated with future CHD events beyond traditional risk factors and modestly improve risk prediction in older adults.

Full-text preview

Available from:
  • Source
    • "The most important contributing factors to the association between walking speed and mortality were inflammatory markers; their role was also apparent after excluding participants with stroke, CHD, or diabetes . Elevated inflammatory markers are associated with a wide range of conditions, including clinical and subclinical cardiovascular disease (Ridker et al. 2000a; Ridker et al. 2000b; Rodondi et al. 2010), diabetes, pulmonary disease, and chronic kidney disease, many of which are mortality risk factors (Chang et al. 2010). There is also an evidence to suggest that chronic inflammation represents a feature of the aging process itself (Franceschi et al. 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Slow walking speed is associated with increased mortality in the elderly, but it is unknown whether a similar association is present in late midlife. Our aim was to examine walking speed in late midlife as a predictor of mortality, as well as factors that may explain this association. Data are drawn from the Whitehall II longitudinal cohort study of British civil servants. The analyses are based on 6,266 participants (29% women; mean age = 61 years, SD = 6) for whom “walking speed at usual pace” was measured over 8 ft (2.44 m) at baseline. Participants were followed for all-cause and cause-specific mortalities during a mean of 6.4 (SD = 0.8) years. During this period, 227 participants died. Participants in the bottom sex-specific third of walking speed (men, <1.26 m/s; women, <1.09 m/s) had an increased risk of death compared to those in the middle and top thirds (age- and sex-adjusted hazard ratio = 1.89, 95% confidence interval (CI) = 1.45–2.46), with no evidence of effect modification by age or sex (interactions, P ≥ 0.40). The association between walking speed and mortality was partially explained by baseline inflammatory markers (percentage reduction of the association 22.8%), height and body mass index (16.6%), chronic diseases (14.0%), and health behaviors (13.4%). Together these and other baseline factors (socioeconomic status, cardiovascular risk factors, cognitive function) explained 48.5% of the association (adjusted hazard ratio = 1.39, 95% CI = 1.04–1.84). In conclusion, walking speed measured in late midlife seems to be an important marker of mortality risk; multiple factors, in particular inflammatory markers, partially explain this association. Electronic supplementary material The online version of this article (doi:10.1007/s11357-012-9387-9) contains supplementary material, which is available to authorized users.
    Full-text · Article · Jun 2013 · Age
  • Source
    • "Moreover, very few studies have compared the relative value of arterial stiffness, inflammatory markers, and endothelial function as correlates of CVD beyond isolated coronary disease events. An epidemiological study of 2,191 elderly (age at baseline 70-79) African American and White subjects, assessed the predictive value of PWV, ankle brachial index (ABI), and inflammatory markers (hsCRP, interleukin-6, and TNF-α) to Framingham risk factors [19]. The outcome variable was limited to coronary disease events. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Preventive cardiology has expanded beyond coronary heart disease towards prevention of a broader spectrum of cardiovascular diseases. Ethnic minorities are at proportionately greater risk for developing extracoronary vascular disease including heart failure and cerebrovascular disease. We performed a cross sectional study of Latino and White hypertension patients in a safety-net healthcare system. Framingham risk factors, markers of inflammation (hsCRP, LPpLA2), arterial stiffness (Pulse wave velocity, augmentation index, and central aortic pressure), and endothelial function (brachial artery flow-mediated dilatation) were measured. Univariate and multivariable associations between these parameters and an index of extracoronary atherosclerosis (carotid intima media thickness) was performed. Among 177 subjects, mean age was 62 years, 67% were female, and 67% were Latino. In univariate analysis, markers associated with carotid intima media thickness (IMT) at p<0.25 included pulse wave velocity (PWV), augmentation index (AIx), central aortic pressure (cAP), and LpPLA2 activity rank. However, AIx, cAP, and LpPLA2 activity were not significantly associated with carotid IMT after adjusting for Framingham risk factors (all p>.10). Only PWV retained a significant association with carotid IMT independent of the Framingham general risk profile parameters (p=.016). No statistically significant interactions between Framingham and other independent variables with ethnicity (all p>.05) were observed. In this safety net cohort, PWV is a potentially useful adjunctive atherosclerotic risk marker independent of traditional risk factors and irrespective of ethnicity.
    Full-text · Article · Apr 2011 · BMC Cardiovascular Disorders
  • [Show abstract] [Hide abstract]
    ABSTRACT: A comparative study of the different preparation conditions required to produce supported copper catalysts by the wet impregnation (WI) and the ion-exchange (IE) methods has been carried out. Two silicas with different textural characteristics, and one form of naturally occurring pumice were used as supports. In order to obtain specific chemical species of copper in solution as well as different support reactivities, three different pH values (1, 4.5 and 11.5) for the impregnating solution were tested. The catalysts were characterized by means of different techniques, such as XFS, BET, TPR, dissociative chemisorption of N2O, XRD, TEM, EXAFS and XANES and methanol (MeOH) dehydrogenation. The use of copper solutions with high pH, especially after several hours of contact with the chosen carrier, with high solution volume to pore volume ratios, modifies strongly the support texture decreasing the specific surface areas (SSA) of the final catalyst. Copper particle sizes lower than a critical limit, or that did not fulfill a certain ensemble requirement, were not active for methanol dehydrogenation indicating that below such limit, this might be a structure-sensitive reaction. A catalyst (WI-11A) prepared by a simple incipient wetness impregnation method at an alkaline pH similar to that used for the IE technique, showed high dispersion and it was simply activated under reaction conditions (MeOH/N2, 230°C) giving conversions around 50% and selectivities to methyl formate (MF) in the order of 75–80% with no deactivation observed after 3h of time on stream.
    No preview · Article · Nov 2000 · Applied Catalysis A General
Show more