Interleukin-1 receptor antagonist, interleukin-6, and C-reactive protein as predictors of mortality in nonagenarians: the vitality 90+ study.

BACKGROUND: Inflammation plays a major role in both aging and chronic disease. Longitudinal studies in very old people can improve our understanding of these processes. We investigated blood levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1ra), and their combinations as predictors of mortality in nonagenarians. METHODS: This is a prospective population-based study including both community-dwelling and institutionalized nonagenarians enrolled in the Vitality 90+ Study. Altogether 285 persons participated in the baseline interview and gave blood. Information on chronic disease was drawn from health center registers. Data on mortality over 4 years were obtained from the Population Register Center. In Cox proportional hazards models, chronic disease and major risk factors were adjusted for. RESULTS: Plasma levels of IL-1ra, IL-6, and CRP were higher in persons who died during the follow-up than in those who survived. When sex, education, cardiovascular disease, diabetes, cancer, history of infections, high density lipoprotein cholesterol, Mini-Mental State Examination, body mass index, smoking status, and exercise were adjusted for, only IL-1ra was a significant predictor of mortality (hazard ratio [HR] 2.12; 95% confidence interval [CI], 1.24-3.62). Persons in the upper tertiles of both CRP and IL-1ra (HR 2.72; 95% CI, 1.25-6.00), or in the upper tertile of all three markers (HR 2.34; 95% CI, 1.23-4.61), had higher mortality than those who were not in the upper tertile in any of the markers. CONCLUSIONS: IL-1ra is a powerful prognostic marker in very old people. Our results implicate its role in the complex interaction between inflammatory markers in aging and disease.

IgA levels are predictors of mortality in Finnish nonagenarians.

It has been demonstrated that in obviously healthy, very old people increased levels of inflammatory markers as well as some defects in T lymphocyte populations are strong predictors of mortality. Very little is known about the role of possible functional defects in antibody formation. To examine this, we now measured IgM, IgG and IgA concentrations in a cohort of 285 nonagenarians (67 males, 218 females). IgG and IgA levels were significantly higher than those of healthy middle-aged controls. The analyzed serum samples were taken at the age of 90-91 years. After 4 years, 20 males and 94 females had survived. To analyze the role in predicting mortality, the immunoglobulin data (as well as the measured CRP and IL-6 concentrations) were stratified according to this survival data. IgA levels (and CRP and IL-6 levels) were clearly higher in the nonsurvivors than in the survivors. These data imply that elevated serum IgA level, i.e. indicator of intestinal inflammation and/or defect in mucosal defence, is a strong mortality predicting factor.

Old people, alcohol use and mortality. A ten-year prospective study.

BACKGROUND AND AIMS: Several studies suggest an association between lower mortality and moderate drinking, particularly wine-drinking, compared with abstainers, in middle-aged populations. The aim of this study was to examine the association of drinking frequencies and beverage types with all-cause mortality among old people. METHODS: A prospective population study with a 10-year follow-up of mortality was carried out in the city of Tampere, Finland, population approximately 180,000. The sample consisted of 365 men and 402 women aged 60-99 years. All-cause mortality was used as the main outcome measure. RESULTS: Death occurred in 182 men and 158 women. Mortality was lowest among frequent and occasional drinkers, second lowest among abstainers, and highest among ex-drinkers. In a Cox proportional hazard model, drinking showed an independent protective effect on mortality. After adjustment for age, sex, educational level, marital status, chronic diseases, functional ability and smoking, the relative risk (RR) of mortality for frequent drinkers was 0.6 (95% CI 0.4-0.8), for occasional drinkers 0.7 (95% CI 0.5-1.0) and for ex-drinkers 1.1 (95% CI 0.8-1.7), compared with abstainers. Adjusted for other mortality risk factors, the mortality of those who drank wine was lower than that of abstainers. CONCLUSIONS: Findings suggest that drinking, and perhaps wine-drinking in particular, is associated with lower mortality even in old age. Future studies are needed to identify the possible role of background characteristics of different drinking pattern groups.