Interleukin (IL)-6, C-reactive protein, and macroalbuminuria are
significant predictors of congestive heart failure, independent of
obesity and other established risk factors, according to new
findings from the Multi-Ethnic Study of Atherosclerosis (MESA).

It also appears likely that inflammation is involved in the
relationship between obesity and congestive heart failure, Dr. Joao
A. C. Lima, at Johns Hopkins University in Baltimore, and colleagues
report in the Journal of the American College of Cardiology for May
6.

The MESA cohort was comprised of 6814 subjects aged 45 to 84 years
who were free of clinically apparent cardiovascular disease at
baseline between 2000 and 2002.

During median follow-up of 4.0 years, 79 subjects developed
congestive heart failure; 26 had an MI before diagnosis of CHF.

In multivariable analyses, serum IL-6, C-reactive protein, and
macroalbuminuria independently predicted incident congestive heart
failure.

The association between metabolic syndrome and congestive heart
failure "is mainly related to impaired glucose metabolism,
hypertension, abdominal obesity, and the pro-inflammatory state that
characterizes the metabolic syndrome," the investigators report.

They also observed that the association of obesity with incident
congestive heart failure was no longer significant after factoring
in inflammatory markers. Thus, they posit, "the association of
obesity and congestive heart failure may be related to
pathophysiologic pathways associated with inflammation."

They note, however, that inflammatory markers and obesity were
measured at the same time, so further research is needed to
elucidate the link between the two factors.

"Physicians need to monitor their obese patients for early signs of
inflammation in the heart and to use this information in determining
how aggressively to treat the condition," Dr. Lima recommends in a
Johns Hopkins media release.

J Am Coll Cardiol 2008;51:1775-1783.