American Journal of Epidemiology Advance Access originally published online on January 10, 2007
American Journal of Epidemiology 2007 165(6):684-695; doi:10.1093/aje/kwk057
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ORIGINAL CONTRIBUTIONS |
Inflammation Biomarkers and Near-Term Death in Older Men
1 Department of Pathology, College of Medicine, University of Vermont, Burlington, VT
2 Department of Biostatistics, University of Washington, Seattle, WA
3 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA
4 Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA
5 Department of Medicine, School of Medicine, University of Washington, Seattle, WA
6 Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
7 Department of Medicine, University of California Davis Medical Center, Sacramento, CA
8 Department of Biochemistry, College of Medicine, University of Vermont, Burlington, VT
Correspondence to Dr. Russell P. Tracy, Department of Pathology, University of Vermont, Colchester Research Facility, 208 South Park Drive, Suite 2, Colchester, VT 05446 (e-mail: Russell.Tracy{at}uvm.edu (cc: Nancy.Jenny{at}uvm.edu)).
Received for publication November 4, 2005. Accepted for publication August 28, 2006.
Associations of C-reactive protein (CRP) and fibrinogen with death may weaken over time. Combining both markers may improve prediction of death in older adults. In 5,828 Cardiovascular Health Study participants (United States, 1989–2000), 383 deaths (183 cardiovascular disease (CVD)) in years 1–3 (early) and 914 deaths (396 CVD) in years 4–8 (late) occurred. For men, when comparing highest to lowest quartiles, hazard ratios for early death were 4.1 (95% confidence interval (CI): 2.7, 6.3) for CRP and 4.1 (95% CI: 2.7, 6.4) for fibrinogen in models adjusted for CVD risk. For early CVD death, hazard ratios were 4.3 (95% CI: 2.2, 8.4) and 3.4 (95% CI: 1.8, 6.3), respectively. When comparing men in the highest quartiles of both biomarkers with those in the lowest, hazard ratios were 9.6 (95% CI: 4.3, 21.1) for early death and 13.5 (95% CI: 3.2, 56.5) for early CVD death. Associations were weaker for late deaths. For women, CRP (hazard ratio = 2.3, 95% CI: 1.4, 3.9), but not fibrinogen (hazard ratio = 1.3, 95% CI: 0.8, 2.2), was associated with early death. Results were similar for CVD death. Neither was associated with late deaths. CRP and fibrinogen were more strongly associated with death in older men than women and more strongly associated with early than late death. Combining both markers may identify older men at greatest risk of near-term death.
aged; C-reactive protein; cardiovascular diseases; death; fibrinogen
Abbreviations: CI, confidence interval; CRP, C-reactive protein; CVD, cardiovascular disease; SD, standard deviation
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