The Relation of Markers of Inflammation to the Development of Glucose Disorders in the Elderly
The Cardiovascular Health Study
- Joshua I. Barzilay1,
- Linn Abraham2,
- Susan R. Heckbert3,
- Mary Cushman4,
- Lewis H. Kuller5,
- Helaine E. Resnick6 and
- Russell P. Tracy7
- 1Division of Endocrinology, Kaiser Permanente of Georgia, and the Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia
- 2Department of Biostatistics, University of Washington, Seattle, Washington
- 3Department of Epidemiology, University of Washington, Seattle, Washington
- 4Department of Medicine, University of Vermont College of Medicine, Colchester, Vermont
- 5Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- 6Medstar Research Institute, Washington, D.C.
- 7Department of Pathology, University of Vermont College of Medicine, Colchester, Vermont
Several studies suggest that inflammation plays a role in the pathogenesis of some glucose disorders in adults. We tested this hypothesis in a longitudinal cohort study of older individuals who had normal fasting glucose (FG) values at baseline. We compared the baseline levels of six inflammatory markers in participants who had developed glucose disorders at follow-up with those of participants whose FG remained normal at follow-up. Participants were members of the Cardiovascular Health Study, a prospective study of risk factors for cardiovascular disease in adults ≥65 years. All 5,888 participants had baseline testing, including FG and markers of inflammation: white blood cell and platelet counts and albumin, fibrinogen, C-reactive protein (CRP), and factor VIIIc levels. At 3–4 years of follow-up, 4,481 (84.5%) of those who were alive had FG levels retested. Participants who developed diabetes (n = 45) had higher median levels of CRP at baseline than those who remained normoglycemic. On multivariate analysis, those with elevated CRP levels (75th percentile [2.86 mg/l] vs. 25th percentile [0.82 mg/l]) were 2.03 times (95% confidence intervals, 1.44–2.86) more likely to have diabetes on follow-up. Adjustment for confounders and other inflammatory markers did not appreciably change this finding. There was no relationship between the development of diabetes and other markers of inflammation. Inflammation, as measured by CRP levels, is associated with the development of diabetes in the elderly. Understanding the role of inflammation in the pathogenesis of glucose disorders in this age-group may lead to better classification and treatment of glucose disorders among them.
Address correspondence and reprint requests to Joshua Barzilay, MD, Kaiser Permanente of Georgia, 200 Crescent Center Parkway, Tucker, GA 30084. E-mail:.
Received for publication 4 August 2001 and accepted in revised form 26 June 2001.
ADA, American Diabetes Association; BMI, body mass index; CRP, C-reactive protein; CVD, cardiovascular disease; FG, fasting glucose; IFG, impaired fasting glucose; OR, odds ratio.