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Medenwald D, Loppnow H, Kluttig A, Nuding S, Greiser KH, Thiery J, Tiller D, Herzog B, Werdan K, Haerting J. Educational level and chronic inflammation in the elderly--the role of obesity: results from the population-based CARLA study. Clin Obes 2015; 5:256-65. [PMID: 26230620 DOI: 10.1111/cob.12107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/29/2015] [Accepted: 06/13/2015] [Indexed: 12/21/2022]
Abstract
This study aimed to assess the mediating role of anthropometric parameters in the relation of education and inflammation in the elderly. Cross-sectional data from the population-based CARdio-vascular Disease, Living and Ageing in Halle study were used after excluding subjects with a plasma level of high-sensitive C-reactive protein (hsCRP) above 10 mg L(-1) (916 men/760 women remaining). Education was categorized in accordance with International Standard Classification of Education. As inflammation parameters, the soluble tumour necrosis factor type 1 (sTNF-R1), hsCRP and interleukin 6 (IL-6) were taken into account. Anthropometric parameters were the body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHeR). We used covariate adjusted mixed models to assess associations. Effect measures were the natural indirect effect (NIE), controlled direct effect and total effect (TE). Education was associated with sTNF-R1, hsCRP and IL-6 in men, and sTNF-R1 and hsCRP in women. Anthropometric parameters correlated with all inflammation parameters after covariate adjustment. BMI and WHeR were strong mediators of educational differences in sTNF-R1 (percentage of NIE of TE: 28% in men; 33% in women) and hsCRP (percentage of NIE of TE: 35% in men; 52% in women), while WHR was the weakest mediator. General obesity mediates roughly one-third of the association of education with chronic inflammation in the elderly.
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Affiliation(s)
- D Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - H Loppnow
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - A Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - S Nuding
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - K H Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - J Thiery
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - D Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - B Herzog
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - K Werdan
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - J Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Medenwald D, Girndt M, Loppnow H, Kluttig A, Nuding S, Tiller D, Thiery JJ, Greiser KH, Haerting J, Werdan K. Inflammation and renal function after a four-year follow-up in subjects with unimpaired glomerular filtration rate: results from the observational, population-based CARLA cohort. PLoS One 2014; 9:e108427. [PMID: 25259714 PMCID: PMC4178159 DOI: 10.1371/journal.pone.0108427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/20/2014] [Indexed: 12/03/2022] Open
Abstract
Background There is evidence that chronic inflammation is associated with the progression/development of chronic renal failure; however, relations in subjects with preserved renal function remain insufficiently understood. Objective To examine the association of inflammation with the development of renal failure in a cohort of the elderly general population. Methods After excluding subjects with reduced estimated glomerular filtration rate (eGFR<60 mL/min/1.73 m2) and missing data, the cohort incorporated 785 men and 659 women (aged 45–83 years). Follow-up was performed four years after baseline. Covariate adjusted linear and logistic regression models were used to assess the association of plasma/serum concentrations of soluble tumour necrosis factor receptor 1 (sTNF-R1), C-reactive protein (CRP), and interleukin 6 (IL-6) with change in eGFR/creatinine. The areas under the curve (AUCs) from receiver operating characteristics (ROCs) were estimated. Results In adjusted models sTNF-R1 was distinctively associated with a decline in eGFR in men (0.6 mL/min/1.73 m2 per 100 pg/mL sTNF-R1; 95% CI: 0.4–0.8), but not in women. A similar association could not be found for CRP or IL-6. Estimates of sTNF-R1 in the cross-sectional analyses were similar between sexes, while CRP and IL-6 were not relevantly associated with eGFR/creatinine. Conclusion In the elderly male general population with preserved renal function sTNF-R1 predicts the development of renal failure.
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Affiliation(s)
- Daniel Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
- * E-mail:
| | - Matthias Girndt
- Department of Internal Medicine II, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Harald Loppnow
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Sebastian Nuding
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Joachim J. Thiery
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Karin H. Greiser
- German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Karl Werdan
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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Inflammation and prolonged QT time: results from the Cardiovascular Disease, Living and Ageing in Halle (CARLA) study. PLoS One 2014; 9:e95994. [PMID: 24770373 PMCID: PMC4000193 DOI: 10.1371/journal.pone.0095994] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/02/2014] [Indexed: 11/19/2022] Open
Abstract
Background Previous research found an association of CRP with QT time in population based samples. Even more, there is evidence of a substantial involvement of the tumor necrosis factor-alpha system in the pathophysiology of cardiac arrhythmia, while the role of Interleukin 6 remains inconclusive. Objective To determine the association between inflammation with an abnormally prolonged QT-time (APQT) in men and women of the elderly general population. Methods Data descend from the baseline examination of the prospective, population-based Cardiovascular Disease, Living and Ageing in Halle (CARLA) Study. After exclusion of subjects with atrial fibrillation and missing ECG recording the final study cohort consisted of 919 men and 797 women. Blood parameters of inflammation were the soluble TNF-Receptor 1 (sTNF-R1), the high-sensitive C-reactive protein (hsCRP), and Interleukin 6 (IL-6). In accordance with major cardiologic societies we defined an APQT above a QT time of 460 ms in women and 450 ms in men. Effect sizes and the corresponding 95% confidence intervals (CI) were estimated by performing multiple linear and logistic regression analyses including the analysis of sex differences by interaction terms. Results After covariate adjustment we found an odds ratio (OR) of 1.89 (95% CI: 1.13, 3.17) per 1000 pg/mL increase of sTNF-R1 in women, and 0.74 (95% CI: 0.48, 1.15) in men. In the covariate adjusted linear regression sTNF-R1 was again positively associated with QT time in women (5.75 ms per 1000 pg/mL, 95% CI: 1.32, 10.18), but not in men. Taking possible confounders into account IL-6 and hsCRP were not significantly related to APQT in both sexes. Conclusion Our findings from cross-sectional analyses give evidence for an involvement of TNF-alpha in the pathology of APQT in women.
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Medenwald D, Dietz S, Tiller D, Kluttig A, Greiser K, Loppnow H, Thiery J, Nuding S, Russ M, Fahrig A, Haerting J, Werdan K. Inflammation and echocardiographic parameters of ventricular hypertrophy in a cohort with preserved cardiac function. Open Heart 2014; 1:e000004. [PMID: 25332774 PMCID: PMC4189296 DOI: 10.1136/openhrt-2013-000004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/01/2014] [Accepted: 01/05/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the association between inflammation and selective echocardiographic parameters (EP) characteristic for ventricular hypertrophy in cross-sectional and longitudinal population-based analyses. METHODS Baseline (711 men, 659 women: 45-83 years) and 4-year follow-up data (622 men, 540 women) of the prospective, population-based CARdio-vascular disease, Living and Ageing in Halle (CARLA)study after exclusion of participants with cardiacvascular diseases were analysed. Inflammation parameters: soluble tumour necrosis factor receptor 1 (sTNF-R1), high-sensitivity C reactive protein (hsCRP) and interleukin 6 (IL-6). EPs: left ventricular mass (LVM), left atrial systolic dimension (LADS), interventricular septum diameter (IVSD), posterior wall dimension (PWD), left ventricular diastolic diameter (LVDD), ejection fraction according to Teichholz (EF). For the longitudinal analyses baseline to follow-up differences were considered. Effect sizes were determined by using multiple linear regression and mixed models. Missing values were replaced by means of multiple imputations. RESULTS Men had higher sTNF-R1 levels; means of hsCRP and IL-6 were similar in men and women. In multiple regression models, sTNF-R1 was associated with LADS (1.4 mm/1000 pg/mL sTNF-R1, 95% CI 0.6 to 2.1) in men. Respecting confounder hsCRP was associated with LVM (5.2 g/10 mg/L hsCRP, 95% CI 1.6 to 8.8), IVSD (0.2 mm/10 mg/L hsCRP, 95% CI 0 to 0.3) and PWD (0.2 mm/10 mg/L hsCRP, 95% CI 0.1 to 0.3) in women, while there were no relevant effects in analysis of IL-6 in both sexes. The baseline to follow-up change in EPs was not relevantly associated with sTNF-R1, hsCRP or IL-6. CONCLUSIONS STNF-R1, hsCRP and IL-6 were inadequate predictors for structural changes of the heart at follow-up, while weak cross-sectional associations are restricted to certain EPs and depend on sex.
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Affiliation(s)
- D Medenwald
- Biostatistics and Informatics , Institute of Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - S Dietz
- Department of Medicine III , Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - D Tiller
- Biostatistics and Informatics , Institute of Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - A Kluttig
- Biostatistics and Informatics , Institute of Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - Kh Greiser
- Division of Cancer Epidemiology , German Cancer Research Centre , Heidelberg , Germany
| | - H Loppnow
- Department of Medicine III , Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - J Thiery
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig , Leipzig , Germany
| | - S Nuding
- Department of Medicine III , Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - M Russ
- Department of Pneumology and Cardiology , Amper Kliniken AG, Klinikum Dachau , Dachau , Germany
| | - A Fahrig
- Department of Medicine III , Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - J Haerting
- Biostatistics and Informatics , Institute of Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - K Werdan
- Department of Medicine III , Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
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