Because low-grade inflammation may play a role in the pathogenesis of coronary heart disease (CHD), and pro-inflammatory cytokines govern inflammatory cascades, this study aimed to assess the associations of several pro-inflammatory cytokines and CHD risk in a new prospective study, including meta-analysis of prospective studies.

Interleukin-6 (IL-6), IL-18, matrix metalloproteinase-9 (MMP-9), soluble CD40 ligand (sCD40L), and tumour necrosis factor-α (TNF-α) were measured at baseline in a case-cohort study of 1514 participants and 833 incident CHD events within population-based prospective cohorts at the Danish Research Centre for Prevention and Health. Age- and sex-adjusted hazard ratios (HRs) for CHD per 1-SD higher log-transformed baseline levels were: 1.37 (95% CI: 1.21–1.54) for IL-6, 1.26 (1.11–1.44) for IL-18, 1.30 (1.16–1.46) for MMP-9, 1.01 (0.89–1.15) for sCD40L, and 1.13 (1.01–1.27) for TNF-α. Multivariable adjustment for conventional vascular risk factors attenuated the HRs to: 1.26 (1.08–1.46) for IL-6, 1.12 (0.95–1.31) for IL-18, 1.21 (1.05–1.39) for MMP-9, 0.93 (0.78–1.11) for sCD40L, and 1.14 (1.00–1.31) for TNF-α. In meta-analysis of up to 29 population-based prospective studies, adjusted relative risks for non-fatal MI or CHD death per 1-SD higher levels were: 1.25 (1.19–1.32) for IL-6; 1.13 (1.05–1.20) for IL-18; 1.07 (0.97–1.19) for MMP-9; 1.07 (0.95–1.21) for sCD40L; and 1.17 (1.09–1.25) for TNF-α.

Several different pro-inflammatory cytokines are each associated with CHD risk independent of conventional risk factors and in an approximately log-linear manner. The findings lend support to the inflammation hypothesis in vascular disease, but further studies are needed to assess causality.