Inflammatory Markers Predict Congestive Heart Failure 

Inflammatory markers are independent predictors of congestive heart failure (CHF) and likely reflect the link between obesity and CHF, a new study suggests. “The implication may be that greater control of obesity may reduce the risk of heart failure and down the road, maybe targeting inflammatory markers may reduce the risk of heart failure related to obesity In a new analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), researchers led by Dr Hossein Bahrami (Johns Hopkins, Baltimore, MD) report that serum interleukin-6 (IL-6), C-reactive protein (CRP), and albuminuria all predicted the development of CHF over four years, independent of obesity or other established risk factors.

"Our results suggest that inflammation might be involved, directly or as a marker of other underlying conditions, in the pathologic pathways that link obesity to left ventricular [LV] dysfunction and ultimately CHF," Bahrami et al write.

Authors of the study calculated the hazard ratios (HRs) linking baseline metabolic syndrome, inflammatory markers, insulin resistance, and albuminuria with incidence CHF in the MESA population, after taking into account standard risk factors, interim myocardial infarction (MI), and left ventricular structure and function. MESA enrolled 6814 participants from multiple ethnic backgrounds; median follow-up for the current analysis was four years.

Baharmi and colleagues report that 79 patients developed CHF during follow-up: while obesity was significantly associated with subsequent CHF, the association lost statistical significance after inflammatory markers were included in the model. Obese patients, however were found to have much higher levels of interleukin 6, CRP, and fibrinogen.

According to Baharmi, the findings suggest a mechanistic link between obesity, inflammation, and CHF.

Inflammation may also help explain the link between the metabolic syndrome and CHF risk: inflammation is a known characteristic of the metabolic syndrome, and metabolic syndrome is associated with a higher risk of developing CHF, the authors note.

Practice Pearls

• Among traditional risk factors for CHF, abdominal obesity and plasma glucose levels for the metabolic syndrome and interim MI are strong predictors.
• Inflammatory markers and macroalbuminuria and microalbuminuria are strong independent predictors for CHF.

Bahrami H, Bluemke DA, Kronmal R, et al. Novel metabolic risk factors for incident heart failure and their relationship with obesity. The Multi-Ethnic Study of Atherosclerosis Study. J Am Coll Cardiol. 2008;51:1775-1783.  The study appears in the May 6, 2008 issue of the Journal of the AmericanCollege of Cardiology.

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