European Heart Journal Advance Access originally published online on February 25, 2008
European Heart Journal 2008 29(6):800-809; doi:10.1093/eurheartj/ehn049
Biomarkers of inflammation predict both vascular and non-vascular mortality in older men
1 Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Richard Doll Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
2 Department of Epidemiology and Public Health, University College London Medical School, London WCIE 6BT, UK
3 London School of Hygiene and Tropical Medicine, Keppel Street, London WCIE 7HT, UK
Received 8 August 2007; revised 22 November 2007; accepted 16 January 2008; online publish-ahead-of-print 25 February 2008.
* Corresponding author. Tel: +44 1865 743743, Fax: +44 1865 743985, Email: robert.clarke{at}ctsu.ox.ac.uk
Aims: To compare the predictive value of inflammatory biomarkers and lipids for vascular and non-vascular mortality in older men.
Methods and results: The relevance of inflammatory biomarkers and lipids for vascular and non-vascular mortality was assessed in a prospective study of 5360 men (mean age 77 years) followed for 7 years. Vascular mortality was positively associated with log C-reactive protein (lnCRP), fibrinogen and total/HDL-C (high-density lipoprotein cholesterol), and inversely associated with albumin [age adjusted hazard ratio (HR) per 2-SD higher usual level (approximately the difference between the top and the bottom thirds of the distribution): 2.09 for lnCRP; 1.70 for fibrinogen; 0.50 for albumin and 1.45 for total/HDL-C]. The associations with the inflammatory markers were attenuated after adjustment for established risk factors, including lipids [adjusted HRs: 1.86 (lnCRP); 1.44 (fibrinogen); 0.51 (albumin)], and further attenuated (and, for fibrinogen, no longer predictive) after adjustment for each other [fully adjusted HRs: 1.60 (lnCRP); 1.01 (fibrinogen); 0.61 (albumin)]. Higher CRP and lower albumin levels were also associated with significantly raised non-vascular mortality independently of other characteristics [fully adjusted HRs: 1.62 (lnCRP); 0.65 (albumin)].
Conclusion: In this cohort of older men, higher CRP and lower albumin levels strongly predicted both vascular and non-vascular mortality, independently of other characteristics.
Key Words: C-reactive protein • Lipids • Prediction of mortality in old age
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