January 28, 2010American Journal of Epidemiology103 citationsOpen Access

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

NRNicolas Rodondi PMPedro Marques‐Vidal JBJaved Butler

Structured PICO

Do markers of atherosclerosis and inflammation improve prediction of coronary heart disease events beyond traditional risk factors in older adults?

Population

2,191 community-dwelling adults aged 70-79 years without overt cardiovascular disease at baseline, mean age 73.5, 55.3% female, 41.1% black, US-based (Pittsburgh, Pennsylvania, and Memphis, Tennessee).

Intervention

Measurement of atherosclerosis markers (ankle-arm index [AAI] and aortic pulse wave velocity [aPWV]) and inflammatory markers (C-reactive protein [CRP], interleukin-6 [IL-6], and tumor necrosis factor-alpha [TNF-alpha]) added to traditional risk factors.

Comparator

Traditional cardiovascular disease risk factors alone (Framingham Risk Score components including age, gender, total and high density lipoprotein cholesterol, systolic blood pressure, smoking, and diabetes).

Outcome

Incident myocardial infarction or CHD death ('hard' events) and 'hard' events plus hospitalization for angina or coronary revascularization (total CHD events) at median 8.2 years follow-up, adjudicated by a blinded panel of clinicians.composite

In older adults, IL-6 and ankle-arm index (AAI) are associated with future CHD events beyond traditional risk factors and modestly improve risk prediction and reclassification.

Abstract

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.

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