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Impact of viral and bacterial infectious burden on long-term prognosis in patients with coronary artery disease
H J Rupprecht1, S Blankenberg, C Bickel
1Department of Medicine II , Johannes Gutenberg University Mainz, Mainz, Germany.rupprecht@2-med.klinik.uni-mainz.de
Circulation
|July 4, 2001
Summary
Increased infectious burden, the number of pathogens an individual is exposed to, independently predicts long-term cardiac death risk in patients with coronary artery disease (CAD). Higher pathogen counts correlate with significantly elevated mortality rates.
Area of Science:
- Infectious disease
- Cardiovascular medicine
- Immunology
Background:
- Coronary artery disease (CAD) risk may correlate with infectious burden.
- Previous studies suggest a link between pathogen exposure and cardiovascular events.
- The impact of aggregate pathogen burden on fatal cardiac events in CAD patients requires further investigation.
Purpose of the Study:
- To evaluate the effect of 8 specific pathogens and overall infectious burden on the risk of future fatal cardiac events.
- To assess the independent contribution of infectious burden to long-term prognosis in patients with documented CAD.
- To determine if pathogen burden is an independent predictor of cardiovascular mortality in CAD patients.
Main Methods:
- Prospective study involving 1018 patients with angiographically documented CAD.
- Measured IgG or IgA antibodies for 8 pathogens: HSV-1, HSV-2, CMV, EBV, H. influenzae, C. pneumoniae, M. pneumoniae, H. pylori.
- Assessed highly sensitive C-reactive protein and tracked cardiovascular events over a mean follow-up of 3.1 years.
Main Results:
- Seropositivity to Epstein-Barr virus, H. pylori, and herpes simplex virus type 2 were independently associated with increased cardiovascular death risk.
- An increasing number of pathogen exposures significantly predicted long-term prognosis (P<0.0001).
- Patients with >5 pathogen seropositivities had a 5.1-fold higher risk of cardiac death compared to those with <4, driven by Herpesviridae.
Conclusions:
- The number of infectious pathogens an individual has been exposed to independently contributes to the long-term prognosis in patients with documented CAD.
- Infectious burden is a significant predictor of mortality in CAD patients.
- This finding supports the hypothesis linking infectious exposure to cardiovascular disease progression.
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