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Original Articles

Metabolic Syndrome, Inflammation, and Incident Heart Failure in the Elderly

The Cardiovascular Health Study

Takeki Suzuki, MD; Ronit Katz, DPhil; Nancy Swords Jenny, PhD; Neil A. Zakai, MD; Martin M. LeWinter, MD; Joshua I. Barzilay, MD and Mary Cushman, MD, MSc

From the Department of Medicine (T.S., N.A.Z., M.M.L., M.C.), University of Vermont College of Medicine, Burlington; Collaborative Health Studies Coordinating Center (R.K.), Department of Biostatistics, University of Washington, Seattle; Department of Pathology (N.S.J.), University of Vermont College of Medicine, Burlington; and Department of Medicine (J.I.B.), Emory University, Atlanta, Ga.

Correspondence to Mary Cushman, MD, MSc, Department of Medicine, University of Vermont, 208 South Park Dr, Suite 2, Colchester, VT 05446. E-mail mary.cushman{at}uvm.edu

Received August 21, 2007; accepted September 19, 2008.

Background— Inflammation markers and metabolic syndrome (MetS) are associated with risk of congestive heart failure (CHF). We evaluated whether combining inflammation markers and MetS provided additive information for incident CHF and if incorporating inflammation markers to the MetS definition added prognostic information.

Methods and Results— We studied 4017 men and women 65 years old, without baseline CHF or diabetes, participating in the Cardiovascular Health Study, an observational study with 12.2 years follow-up and 966 cases of incident CHF. Baseline "C-reactive protein (CRP)-MetS" or "interleukin (IL)-6–MetS" were defined as presence of 3 out of 6 components, with elevated CRP (3 mg/L) or IL-6 (2.21 pg/mL) as a sixth component added to ATPIII criteria. Cox models adjusted for CHF risk factors and incident coronary disease were used to calculate hazard ratios for CHF. MetS and elevated inflammation markers were independently associated with CHF risk (hazard ratios, 95% CI: 1.32, 1.16 to 1.51 for MetS; 1.53, 1.34 to 1.75 for CRP; 1.37, 1.19 to 1.55 for IL-6). There was a 20% relative excess risk attributed to the combination of MetS and CRP (95% CI, –44% to 88%). CRP-MetS and IL-6–MetS definitions reclassified 18% and 13%, respectively of participants as MetS. Both CRP-MetS and IL-6–MetS increased risk of CHF by 60% compared with those without MetS.

Conclusion— MetS and inflammation markers provided additive information on CHF risk in this elderly cohort. Inflammation-incorporated MetS definitions identified more participants with the same risk level as ATPIII MetS. Considering inflammation markers and MetS together may be useful in clinical and research settings.

Key Words: epidemiology • heart failure • metabolism • inflammation

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CLINICAL PERSPECTIVE

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