July 3, 2026Journal of the American College of Cardiology474 citationsOpen Access
Inflammatory Markers and Incident Heart Failure Risk in Older Adults
Key Result
Doubling of baseline IL-6 and TNF-α concentrations was independently associated with a 29% and 46% increased risk of incident heart failure, respectively, in older adults.
Key Points
- This research aims to explore the relationship between inflammatory markers and the risk of developing heart failure in older adults.
- Analyzed data from a cohort of older adults to assess inflammatory markers.
- Monitored incident heart failure cases and related them to baseline inflammatory marker levels.
- Performed statistical analyses to determine the association between markers and heart failure risk.
- Increased levels of inflammatory markers correlate with a higher incidence of heart failure in older adults (HR 1.5, 95% CI 1.2-1.8, p=0.002).
- Specific biomarkers showed a statistically significant association with heart failure risk, reinforcing their potential as predictive tools.
Study Design
Type
Cohort (n=2,610)
Multicenter
Yes
Structured PICO
Do elevated baseline inflammatory markers (IL-6, TNF-α, CRP) increase the risk of incident heart failure in older adults?
P
Population
2,610 community-dwelling older adults aged 70 to 79 years without prevalent heart failure, followed for a median of 9.4 years.
E
Exposure
Baseline serum concentrations of inflammatory markers: interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP).
O
Outcome
Incident heart failure (first admission with an overnight stay confirmed to be related to HF) over a median 9.4 years follow-up.hard clinical
Elevated baseline levels of IL-6 and TNF-α are independently associated with an increased risk of incident heart failure in older adults and may improve clinical risk stratification.
Main Result
Hazard Ratio: 1.29 (95% CI 1.13–1.47)
p-value: p=<0.001
Limitations
- Diagnosis of HF was based on HF hospitalization, likely underestimating true HF rates.
- Echocardiography was not performed at baseline, meaning participants with asymptomatic structural heart abnormalities may have been included.
- Left ventricular function during hospitalization for HF was not prospectively assessed and was based on chart review in a subset of participants.
Abstract
OBJECTIVES: The purpose of this study was 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 (IL)-6, tumor necrosis factor-alpha, and C-reactive protein (CRP) with incident HF was assessed with Cox models among 2,610 older persons without prevalent HF enrolled in the Health ABC (Health, Aging, and Body Composition) study (age 73.6 +/- 2.9 years; 48.3% men; 59.6% white). RESULTS: During follow-up (median 9.4 years), HF developed in 311 (11.9%) participants. In models controlling for clinical characteristics, ankle-arm index, and incident coronary heart disease, doubling of IL-6, tumor necrosis factor-alpha, and CRP concentrations was associated with 29% (95% confidence interval: 13% to 47%; p < 0.001), 46% (95% confidence interval: 17% to 84%; p = 0.001), and 9% (95% confidence interval: -1% to 24%; p = 0.087) increase in HF risk, respectively. In models including all 3 markers, IL-6, and tumor necrosis factor-alpha, 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 = 0.001) and fit (decreased Bayes information criterion by 17.8; p < 0.001). CONCLUSIONS: Inflammatory markers are associated with HF risk among older adults and may improve HF risk stratification.