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Cytomegalovirus seropositivity and C-reactive protein have independent and combined predictive value for mortality in
J B Muhlestein1, B D Horne, J F Carlquist
1LDS Hospital, University of Utah, Salt Lake City 84143, USA. ldbmuhle@ihc.com
Circulation
|October 18, 2000
Summary
Elevated C-reactive protein (CRP) and cytomegalovirus (CMV) infection predict mortality in coronary artery disease (CAD) patients. Combining these markers significantly increases mortality risk, suggesting CMV may accelerate atherosclerosis.
Area of Science:
- Cardiology
- Infectious Disease
- Inflammation Research
Background:
- Inflammation's role in coronary artery disease (CAD) is increasingly recognized.
- Inflammatory markers like C-reactive protein (CRP) and infection markers (Chlamydia pneumoniae, cytomegalovirus [CMV], Helicobacter pylori) are proposed CAD risk factors.
- Further evaluation is needed to confirm associations between inflammation, infection, and CAD outcomes.
Purpose of the Study:
- To prospectively evaluate C-reactive protein (CRP) levels and IgG seropositivity to Chlamydia pneumoniae, cytomegalovirus (CMV), and Helicobacter pylori as predictors of mortality in patients with established coronary artery disease (CAD).
Main Methods:
- Prospective study of 985 patients with angiographically confirmed CAD (stenosis >/=70%).
- Assessed CRP levels and IgG seropositivity to C. pneumoniae, CMV, and H. pylori.
- Followed patients for an average of 2.7 years to determine mortality, controlling for baseline variables using Cox proportional hazards models.
Main Results:
- 110 patients (11.2%) died during follow-up.
- Elevated CRP levels were significantly higher in non-survivors (3.1 mg/dL vs. 1.5 mg/dL).
- Higher CRP tertiles (2nd and 3rd) significantly predicted mortality (HR=2.4).
- CMV seropositivity (HR=1.9) was the only infectious marker predicting mortality.
- Combined elevated CRP and CMV seropositivity showed a strong trend for increased mortality risk (P for trend <0.0001).
- Independent predictors of mortality included age, reduced left ventricular ejection fraction, and diabetes mellitus.
Conclusions:
- Cytomegalovirus (CMV) seropositivity and elevated C-reactive protein (CRP) are independent predictors of mortality in patients with coronary artery disease (CAD).
- The combination of elevated CRP and CMV seropositivity significantly increases mortality risk.
- These findings suggest a potential role for chronic CMV infection in accelerating the atherothrombotic process in CAD patients.
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