Inflammatory Markers and Longitudinal Lung Function Decline in the Elderly

Abstract

Longitudinal studies examining associations of the inflammatory markers fibrinogen and C-reactive protein (CRP) with lung function decline are sparse. The authors examined whether elevated fibrinogen and CRP levels were associated with greater longitudinal lung function decline in the elderly. The Cardiovascular Health Study measured fibrinogen and CRP in 5,790 Whites and African Americans from four US communities aged 65 years or older in 1989–1990 or 1992–1993. Spirometry was performed in 1989–1990 and 4, 7, and 16 years later. Fibrinogen and CRP were inversely associated with lung function at baseline after adjustment for multiple potential confounders. In mixed models, the rate of decline in forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) ratio with increasing age was faster among those with higher baseline fibrinogen (−0.032%/year per standard deviation higher fibrinogen (95% confidence interval: −0.057, −0.0074)) but not among those with higher CRP (−0.0037%/year per standard deviation higher CRP (95% confidence interval: −0.013, 0.0056)). Longitudinal analyses for FEV₁ and FVC yielded results in the direction opposite of that hypothesized, possibly because of the high mortality rate and strong inverse association of FEV₁ and FVC but not FEV₁/FVC with mortality. An alternative approach to missing data yielded similar results. In conclusion, higher levels of fibrinogen, but not CRP, independently predicted greater FEV₁/FVC decline in the elderly.