American Journal of Epidemiology Advance Access originally published online on August 6, 2008
American Journal of Epidemiology 2008 168(6):602-610; doi:10.1093/aje/kwn174
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ORIGINAL CONTRIBUTIONS |
Inflammatory Markers and Longitudinal Lung Function Decline in the Elderly
1 Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
2 Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
3 Department of Medicine, University of Arizona, Tucson, AZ
4 Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
5 Department of Internal Medicine, School of Medicine, University of California, Davis, CA
6 Department of Medicine, University of Vermont, Burlington, VT
7 Department of Pathology, University of Vermont, Burlington, VT
8 Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
9 Collaborative Health Studies Coordinating Center and Department of Biostatistics, University of Washington, Seattle, WA
10 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
Correspondence to Dr. R. Graham Barr, Columbia University Medical Center, 622 West 168th Street, PH 9 East - Room 105, New York, NY 10032 (e-mail: rgb9{at}columbia.edu).
Received for publication January 9, 2008. Accepted for publication May 21, 2008.
Longitudinal studies examining associations of the inflammatory markers fibrinogen and C-reactive protein (CRP) with lung function decline are sparse. The authors examined whether elevated fibrinogen and CRP levels were associated with greater longitudinal lung function decline in the elderly. The Cardiovascular Health Study measured fibrinogen and CRP in 5,790 Whites and African Americans from four US communities aged 65 years or older in 1989–1990 or 1992–1993. Spirometry was performed in 1989–1990 and 4, 7, and 16 years later. Fibrinogen and CRP were inversely associated with lung function at baseline after adjustment for multiple potential confounders. In mixed models, the rate of decline in forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio with increasing age was faster among those with higher baseline fibrinogen (–0.032%/year per standard deviation higher fibrinogen (95% confidence interval: –0.057, –0.0074)) but not among those with higher CRP (–0.0037%/year per standard deviation higher CRP (95% confidence interval: –0.013, 0.0056)). Longitudinal analyses for FEV1 and FVC yielded results in the direction opposite of that hypothesized, possibly because of the high mortality rate and strong inverse association of FEV1 and FVC but not FEV1/FVC with mortality. An alternative approach to missing data yielded similar results. In conclusion, higher levels of fibrinogen, but not CRP, independently predicted greater FEV1/FVC decline in the elderly.
aged; biological markers; C-reactive protein; fibrinogen; forced expiratory volume; inflammation; spirometry; vital capacity
Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity
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