Published Online
on September 23, 2008

A more recent version of this article appeared on November 1, 2008

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Original Article

Metabolic Syndrome, Inflammation, and the Incident Heart Failure in the Elderly: the Cardiovascular Health Study

Takeki Suzuki¹; Ronit Katz²; Nancy Swords Jenny³; Neil A. Zakai⁴; Martin M. LeWinter¹; Joshua I. Barzilay⁵ and Mary Cushman^6,7

¹ Department of Medicine, University of Vermont, Burlington;
² Department of Biostatistics, University of Washington, Seattle;
³ Department of Pathology, University of Vermont, Burlington;
⁴ Depts. of Medicine, University of Vermont, Burlington; Brown University and Boston Univ., Providence;
⁵ Department of Medicine, Emory University, Atlanta;
⁶ Department of Medicine and Department of Pathology, University of Vermont, Burlington

⁷ E-mail: mary.cushman{at}uvm.edu

Background—Inflammation markers and MetS are associated with risk of CHF. We evaluated whether combining inflammation markers and metabolic syndrome (MetS) provided additive information for incident congestive heart failure (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-6 (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 6th component added to ATPIII criteria. Cox models adjusted for CHF risk factors and incident coronary disease, were used to calculate HRs for CHF. MetS and elevated inflammation markers were independently associated with CHF risk (HRs, 95 % CI: 1.32, 1.16-1.51 for MetS; 1.53, 1.34-1.75 for CRP; 1.37, 1.19-1.55 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 to 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 • inflammation • metabolism

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