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Associations Between Fibrin D ‐Dimer, Markers of Inflammation, Incident Self‐Reported Mobility Limitation, and All‐Cause Mortality in Older Men
Author(s) -
Wannamethee S. Goya,
Whincup Peter H.,
Len Lucy,
Papacosta Olia,
Lowe Gordon D.
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13133
Subject(s) - medicine , d dimer , hazard ratio , fibrinogen , odds ratio , confidence interval , confounding , prospective cohort study , proportional hazards model , c reactive protein , inflammation
Objectives To examine the independent relationships between fibrin D ‐dimer, interleukin 6 ( IL ‐6), C ‐reactive protein ( CRP ), and fibrinogen and incident mobility limitation and mortality. Design Prospective. Setting General practice in 24 B ritish towns. Participants Men aged 60 to 79 without prevalent heart failure followed up for an average of 11.5 years (N = 3,925). Measurements All‐cause mortality (n = 1,286) and self‐reported mobility disability obtained at examination in 1998 to 2000 and in a postal questionnaire 3 to 5 years later in 2003. Results High D ‐dimer (top vs lowest tertile: adjusted odds ratio ( aOR ) = 1.46, 95% confidence interval = 1.02–2.05) and IL ‐6 (a OR = 1.43, 95% CI = 1.01–2.02) levels (but not CRP or fibrinogen) were associated with greater incident mobility limitation after adjustment for confounders and prevalent disease status. IL‐6, CRP , fibrinogen, and D ‐dimer were significantly associated with total mortality after adjustment for confounders. Only D ‐dimer and IL ‐6 predicted total mortality independent of each other and the other biomarkers. The adjusted hazard ratio ( aHR ) was 1.16 (95% CI = 1.10–1.22) for a standard deviation increase in log D ‐dimer and 1.10 (95% CI = 1.04–1.18) for a standard deviation increase in log IL ‐6. D ‐dimer was independently related to vascular and nonvascular mortality, and IL ‐6 was independently related to vascular mortality. Risks of mobility limitation and mortality were greatest in those with a combination of high D ‐dimer and IL ‐6 levels. Conclusion D ‐dimer and IL ‐6 are associated with risk of mobility limitation and mortality in older men without heart failure. The findings suggest that coagulation leads to functional decline and mortality s that inflammation does not explain.