Are Markers of Inflammation More Strongly Associated with Risk for Fatal Than for Nonfatal Vascular Events?
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{"title"=>"Are markers of inflammation more strongly associated with risk for fatal than for nonfatal vascular events?", "type"=>"journal", "authors"=>[{"first_name"=>"Naveed", "last_name"=>"Sattar", "scopus_author_id"=>"7007043802"}, {"first_name"=>"Heather M.", "last_name"=>"Murray", "scopus_author_id"=>"35765569400"}, {"first_name"=>"Paul", "last_name"=>"Welsh", "scopus_author_id"=>"35308260700"}, {"first_name"=>"Gerard J.", "last_name"=>"Blauw", "scopus_author_id"=>"7005764290"}, {"first_name"=>"Brendan M.", "last_name"=>"Buckley", "scopus_author_id"=>"56909574000"}, {"first_name"=>"Stuart", "last_name"=>"Cobbe", "scopus_author_id"=>"35227092200"}, {"first_name"=>"Anton J.M.", "last_name"=>"De Craen", "scopus_author_id"=>"7004695294"}, {"first_name"=>"Gordon D.", "last_name"=>"Lowe", "scopus_author_id"=>"56678958000"}, {"first_name"=>"J. Wouter", "last_name"=>"Jukema", "scopus_author_id"=>"7005836769"}, {"first_name"=>"Peter W.", "last_name"=>"Macfarlane", "scopus_author_id"=>"7102435724"}, {"first_name"=>"Michael B.", "last_name"=>"Murphy", "scopus_author_id"=>"7403900220"}, {"first_name"=>"David J.", "last_name"=>"Stott", "scopus_author_id"=>"13309434700"}, {"first_name"=>"Rudi G.J.", "last_name"=>"Westendorp", "scopus_author_id"=>"7103236448"}, {"first_name"=>"James", "last_name"=>"Shepherd", "scopus_author_id"=>"7401741461"}, {"first_name"=>"Ian", "last_name"=>"Ford", "scopus_author_id"=>"7006691891"}, {"first_name"=>"Chris J.", "last_name"=>"Packard", "scopus_author_id"=>"7103089573"}], "year"=>2009, "source"=>"PLoS Medicine", "identifiers"=>{"issn"=>"15491277", "scopus"=>"2-s2.0-67650217953", "sgr"=>"67650217953", "pui"=>"354890075", "isbn"=>"1549-1277\r1549-1676", "pmid"=>"19554082", "doi"=>"10.1371/journal.pmed.1000099"}, "id"=>"31757bbb-7118-3999-9a15-2afa210f5754", "abstract"=>"BACKGROUND: Circulating inflammatory markers may more strongly relate to risk of fatal versus nonfatal cardiovascular disease (CVD) events, but robust prospective evidence is lacking. We tested whether interleukin (IL)-6, C-reactive protein (CRP), and fibrinogen more strongly associate with fatal compared to nonfatal myocardial infarction (MI) and stroke.\\n\\nMETHODS AND FINDINGS: In the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER), baseline inflammatory markers in up to 5,680 men and women aged 70-82 y were related to risk for endpoints; nonfatal CVD (i.e., nonfatal MI and nonfatal stroke [n = 672]), fatal CVD (n = 190), death from other CV causes (n = 38), and non-CVD mortality (n = 300), over 3.2-y follow-up. Elevations in baseline IL-6 levels were significantly (p = 0.0009; competing risks model analysis) more strongly associated with fatal CVD (hazard ratio [HR] for 1 log unit increase in IL-6 1.75, 95% confidence interval [CI] 1.44-2.12) than with risk of nonfatal CVD (1.17, 95% CI 1.04-1.31), in analyses adjusted for treatment allocation. The findings were consistent in a fully adjusted model. These broad trends were similar for CRP and, to a lesser extent, for fibrinogen. The results were also similar in placebo and statin recipients (i.e., no interaction). The C-statistic for fatal CVD using traditional risk factors was significantly (+0.017; p<0.0001) improved by inclusion of IL-6 but not so for nonfatal CVD events (p = 0.20).\\n\\nCONCLUSIONS: In PROSPER, inflammatory markers, in particular IL-6 and CRP, are more strongly associated with risk of fatal vascular events than nonfatal vascular events. These novel observations may have important implications for better understanding aetiology of CVD mortality, and have potential clinical relevance.", "link"=>"http://www.mendeley.com/research/markers-inflammation-more-strongly-associated-risk-fatal-nonfatal-vascular-events", "reader_count"=>33, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>2, "Researcher"=>7, "Student > Ph. D. Student"=>7, "Student > Postgraduate"=>3, "Student > Master"=>4, "Other"=>4, "Student > Bachelor"=>3, "Professor"=>1, "Student > Doctoral Student"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>2, "Researcher"=>7, "Student > Ph. D. Student"=>7, "Student > Postgraduate"=>3, "Student > Master"=>4, "Other"=>4, "Student > Bachelor"=>3, "Professor"=>1, "Student > Doctoral Student"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>1, "Environmental Science"=>1, "Biochemistry, Genetics and Molecular Biology"=>1, "Medicine and Dentistry"=>20, "Agricultural and Biological Sciences"=>9, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>20}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>9}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Unspecified"=>{"Unspecified"=>1}, "Environmental Science"=>{"Environmental Science"=>1}}, "reader_count_by_country"=>{"Iran"=>1, "United Kingdom"=>1}, "group_count"=>3}

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  • {"files"=>["https://ndownloader.figshare.com/files/893138"], "description"=>"<p>Plot showing associations of 1-unit increase in log IL-6, log CRP, and fibrinogen with HR of endpoints on a log scale (after adjusting for randomized treatment, age, gender, LDL cholesterol, HDL cholesterol, triglycerides, BMI, systolic and diastolic blood pressure, current and exsmoking, diabetes, previous CVD, use of antihypertensive therapy, and country).</p>", "links"=>[], "tags"=>["associations", "1-unit", "fibrinogen", "hr", "endpoints", "adjusting", "randomized", "ldl", "hdl", "systolic", "diastolic", "antihypertensive"], "article_id"=>563560, "categories"=>["Medicine", "Neuroscience"], "users"=>["Naveed Sattar", "Heather M. Murray", "Paul Welsh", "Gerard J. Blauw", "Brendan M. Buckley", "Stuart Cobbe", "Anton J. M. de Craen", "Gordon D. Lowe", "J. Wouter Jukema", "Peter W. Macfarlane", "Michael B. Murphy", "David J. Stott", "Rudi G. J. Westendorp", "James Shepherd", "Ian Ford", "Chris J. Packard"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000099.g002", "stats"=>{"downloads"=>1, "page_views"=>27, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Plot_showing_associations_of_1_unit_increase_in_log_IL_6_log_CRP_and_fibrinogen_with_HR_of_endpoints_on_a_log_scale_after_adjusting_for_randomized_treatment_age_gender_LDL_cholesterol_HDL_cholesterol_triglycerides_BMI_systolic_and_diastolic_blood_pressur/563560", "title"=>"Plot showing associations of 1-unit increase in log IL-6, log CRP, and fibrinogen with HR of endpoints on a log scale (after adjusting for randomized treatment, age, gender, LDL cholesterol, HDL cholesterol, triglycerides, BMI, systolic and diastolic blood pressure, current and exsmoking, diabetes, previous CVD, use of antihypertensive therapy, and country).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-21 05:29:39"}
  • {"files"=>["https://ndownloader.figshare.com/files/893206"], "description"=>"<p>Event groupings as defined in the methods. Fatal CVD deaths preceded by nonfatal CVD are excluded. Model A, adjusted for randomized treatment. Model B, adjusted for randomized treatment, age, gender, LDL cholesterol, HDL cholesterol, systolic blood pressure, current smoker, diabetes, previous CVD (CHD, stroke, peripheral arterial disease, stroke, and transient ischaemic attack), use of antihypertensive therapy, and country. Model C, Model B+ adjusted for log triglyceride, BMI, diastolic blood pressure, exsmoker (as well as current smoker).</p>", "links"=>[], "tags"=>["fibrinogen", "1-unit", "experiencing", "categories"], "article_id"=>563651, "categories"=>["Medicine", "Neuroscience"], "users"=>["Naveed Sattar", "Heather M. Murray", "Paul Welsh", "Gerard J. Blauw", "Brendan M. Buckley", "Stuart Cobbe", "Anton J. M. de Craen", "Gordon D. Lowe", "J. Wouter Jukema", "Peter W. Macfarlane", "Michael B. Murphy", "David J. Stott", "Rudi G. J. Westendorp", "James Shepherd", "Ian Ford", "Chris J. Packard"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000099.t003", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Associations_of_IL_6_CRP_and_fibrinogen_with_risk_HR_for_1_unit_increase_in_log_IL_6_log_CRP_or_fibrinogen_of_experiencing_one_of_the_four_categories_of_events_/563651", "title"=>"Associations of IL-6, CRP, and fibrinogen with risk (HR for 1-unit increase in log IL-6, log CRP, or fibrinogen) of experiencing one of the four categories of events.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 05:30:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/893252"], "description"=>"<p>Event groupings as defined in the methods. Fatal CVD deaths preceded by nonfatal CVD are excluded. <i>p</i>-Value is for interaction between randomized treatment allocation and marker. Unadjusted HR (95% CIs) are presented.</p>", "links"=>[], "tags"=>["fibrinogen", "1-unit", "experiencing", "categories", "events", "baseline"], "article_id"=>563693, "categories"=>["Medicine", "Neuroscience"], "users"=>["Naveed Sattar", "Heather M. Murray", "Paul Welsh", "Gerard J. Blauw", "Brendan M. Buckley", "Stuart Cobbe", "Anton J. M. de Craen", "Gordon D. Lowe", "J. Wouter Jukema", "Peter W. Macfarlane", "Michael B. Murphy", "David J. Stott", "Rudi G. J. Westendorp", "James Shepherd", "Ian Ford", "Chris J. Packard"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000099.t002", "stats"=>{"downloads"=>7, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Associations_of_IL_6_CRP_and_fibrinogen_HR_for_1_unit_increase_in_log_IL_6_log_CRP_and_fibrinogen_of_experiencing_one_of_four_categories_of_events_by_baseline_treatment_allocation_/563693", "title"=>"Associations of IL-6, CRP, and fibrinogen (HR for 1-unit increase in log IL-6, log CRP, and fibrinogen) of experiencing one of four categories of events by baseline treatment allocation.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 05:30:26"}
  • {"files"=>["https://ndownloader.figshare.com/files/893308"], "description"=>"<p>Please note that because of the design structure of the trial—recruiting more participants with hypertension/smokers and diabetes (and women) into the low risk primary prevention group—the significance or nonsignificance of univariate comparisons in this table could be potentially misleading. <i>p</i>-Values for continuous variables are from two-sample <i>t</i>-test and for categorical variables from chi-squared test.</p>a<p>Values are geometric means (SD) calculated from the log-transformed distribution and the (<i>p</i>-value).</p><p>SD, standard deviation; TIA, transient ischemic attack.</p>", "links"=>[], "tags"=>["characteristics", "nonfatal", "endpoint"], "article_id"=>563750, "categories"=>["Medicine", "Neuroscience"], "users"=>["Naveed Sattar", "Heather M. Murray", "Paul Welsh", "Gerard J. Blauw", "Brendan M. Buckley", "Stuart Cobbe", "Anton J. M. de Craen", "Gordon D. Lowe", "J. Wouter Jukema", "Peter W. Macfarlane", "Michael B. Murphy", "David J. Stott", "Rudi G. J. Westendorp", "James Shepherd", "Ian Ford", "Chris J. Packard"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000099.t001", "stats"=>{"downloads"=>2, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Baseline_characteristics_by_incident_primary_combined_nonfatal_and_fatal_endpoint_p_value_versus_no_event_group_/563750", "title"=>"Baseline characteristics by incident primary combined nonfatal and fatal endpoint (<i>p</i>-value versus no event group).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 05:30:43"}
  • {"files"=>["https://ndownloader.figshare.com/files/892985"], "description"=>"<p>Kaplan-Meier time-to-event plots split by tertiles of IL-6 tertiles for (A) nonfatal CVD (<i>n</i> = 667 events), (B) fatal CVD (<i>n</i> = 189 deaths), (C) fatal other CV (<i>n</i> = 37 deaths), and (D) non-CVD mortality (<i>n</i> = 299 deaths).</p>", "links"=>[], "tags"=>["time-to-event", "plots", "tertiles", "il-6", "nonfatal", "cvd", "cv", "non-cvd"], "article_id"=>563406, "categories"=>["Medicine", "Neuroscience"], "users"=>["Naveed Sattar", "Heather M. Murray", "Paul Welsh", "Gerard J. Blauw", "Brendan M. Buckley", "Stuart Cobbe", "Anton J. M. de Craen", "Gordon D. Lowe", "J. Wouter Jukema", "Peter W. Macfarlane", "Michael B. Murphy", "David J. Stott", "Rudi G. J. Westendorp", "James Shepherd", "Ian Ford", "Chris J. Packard"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000099.g001", "stats"=>{"downloads"=>1, "page_views"=>20, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Kaplan_Meier_time_to_event_plots_split_by_tertiles_of_IL_6_tertiles_for_A_nonfatal_CVD_n_667_events_B_fatal_CVD_n_189_deaths_C_fatal_other_CV_n_37_deaths_and_D_non_CVD_mortality_n_299_deaths_/563406", "title"=>"Kaplan-Meier time-to-event plots split by tertiles of IL-6 tertiles for (A) nonfatal CVD (<i>n</i> = 667 events), (B) fatal CVD (<i>n</i> = 189 deaths), (C) fatal other CV (<i>n</i> = 37 deaths), and (D) non-CVD mortality (<i>n</i> = 299 deaths).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-21 05:28:46"}

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Relative Metric

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