Combined elevation of interleukin-6 and coronary artery calcium was associated with an increased risk of total heart failure compared to low levels of both markers (HR 2.00; 95% CI 1.43-2.80).
Cohort (n=6,592)
Yes
Does the joint elevation of interleukin-6 and coronary artery calcium increase the risk of heart failure and its subtypes?
The combined elevation of IL-6 and coronary artery calcium synergistically increases the risk of HFrEF, suggesting that systemic inflammation modifies the relationship between coronary calcification and heart failure risk.
Hazard Ratio: 2 (95% CI 1.43–2.8)
This study investigated the joint association of interleukin-6 (IL-6) and coronary artery calcium (CAC) with the risk of heart failure (HF). Among 6592 participants in the Multi-Ethnic Study of Atherosclerosis (MESA), individuals were categorized into four groups based on CAC (0 vs >0) and IL-6 (cutoff 1.32 pg/mL via Youden’s index): low CAC/low IL-6 (reference), low CAC/high IL-6, high CAC/low IL-6, and high CAC/high IL-6. Multivariable Cox models were used to assess the risk of total heart failure (HF), HF with reduced ejection fraction (HFrEF), and HF with preserved ejection fraction (HFpEF). Compared to the reference group, the hazard ratios (HRs) for total HF were 1.61 (95 % CI, 1.12–2.31) for high IL-6, 1.56 (95 % CI, 1.11–2.20) for high CAC, and 2.00 (95 % CI, 1.43–2.80) when both were elevated (multiplicative interaction p = 0.28). For HFrEF, the risk was significantly higher only when both markers were elevated: HR 2.34 (95 % CI, 1.44–3.81), compared to isolated CAC (1.11; 95 % CI, 0.65–1.87) or IL-6 (1.07; 95 % CI, 0.59–1.95) (multiplicative and additive interaction p = 0.05 and 0.008, respectively). Conversely, for HFpEF, the combined elevation of IL-6 and CAC was associated with a lower risk than either marker alone: HRs 2.13, 2.31, and 2.21, respectively (antagonistic multiplicative interaction, p = 0.02). Combined elevation of IL-6 and CAC was associated with increased HFrEF risk, with significant additive and multiplicative interactions. For HFpEF, combined elevation conferred less risk than either alone. Inflammation modifies the CAC HFrEF relationship and merits further study. *CAC, coronary artery calcium; IL-6, interleukin-6, HF, heart failure; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction. Low IL-6 is defined as a value below 1.32 pg/mL. High IL-6 is defined as a value above 1.32 pg/mL. Low CAC is defined as CAC = 0, and high CAC is defined as CAC > 0.
Ahmad et al. (Tue,) conducted a cohort in heart failure (n=6,592). Combined elevation of interleukin-6 and coronary artery calcium vs. Low CAC and low IL-6 was evaluated on total heart failure (HF) (HR 2.00, 95% CI 1.43-2.80). Combined elevation of interleukin-6 and coronary artery calcium was associated with an increased risk of total heart failure compared to low levels of both markers (HR 2.00; 95% CI 1.43-2.80).