Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 179, Issue 11, Pages 1331-1339Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwu067
Keywords
biomarkers; fibrosis; inflammation; mortality
Categories
Funding
- National Heart, Lung, and Blood Institute [HL118775-01, HL 094555, HL085083, HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC 85083, N01HC85086]
- National Institute on Aging [AG023629]
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Fibrosis has been implicated in diverse diseases of the liver, kidney, lungs, and heart, but its importance as a risk factor for mortality remains unconfirmed. We determined the prospective associations of 2 complementary biomarkers of fibrosis, transforming growth factor-beta (TGF-beta) and procollagen type III N-terminal propeptide (PIIINP), with total and cause-specific mortality risks among community-living older adults in the Cardiovascular Health Study (1996-2010). We measured circulating TGF-beta and PIIINP levels in plasma samples collected in 1996 and ascertained the number of deaths through 2010. Both TGF-beta and PIIINP were associated with elevated risks of total and pulmonary mortality after adjustment for sociodemographic, clinical, and biochemical risk factors. For total mortality, the hazard ratios per doubling of TGF-beta and PIIINP were 1.09 (95% confidence interval (CI): 1.01, 1.17; P = 0.02) and 1.14 (CI: 1.03, 1.27; P = 0.01), respectively. The corresponding hazard ratios for pulmonary mortality were 1.27 (CI: 1.01, 1.60; P = 0.04) for TGF-beta and 1.52 (CI: 1.11, 2.10; P = 0.01) for PIIINP. Associations of TGF-beta and PIIINP with total and pulmonary mortality were strongest among individuals with higher C-reactive protein concentrations (P for interaction < 0.05). Our findings provide some of the first large-scale prospective evidence that circulating biomarkers of fibrosis measured late in life are associated with death.
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