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Enterovirus, mycoplasma and other infections as predictors for myocardial infarction
A Reunanen1, M Roivainen, M Kleemola
1Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland. antti.reunanen@kt1.fi
Insights
Antibodies to enterovirus and mycoplasma pneumoniae, and immune complex-bound antibodies to chlamydia pneumoniae, predict coronary events in men without prior heart disease. Serological evidence of multiple infections also increased risk.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Coronary heart disease (CHD) is a leading cause of mortality.
- The role of infectious agents in CHD pathogenesis is under investigation.
- Predictive markers for major coronary events are crucial for early intervention.
Purpose of the Study:
- To investigate the association between antibodies to five infectious agents and the risk of major coronary events.
- To determine if this association differs between men with and without baseline evidence of coronary heart disease.
Main Methods:
- A case-control study nested within a prospective population cohort.
- Included 441 men aged 45-64 with myocardial infarction or coronary death.
- Matched controls were selected based on age, heart disease status, and residence.
- Antibodies against enterovirus, Mycoplasma pneumoniae, Chlamydia pneumoniae, cytomegalovirus, and adenovirus were measured.
Main Results:
- Elevated antibodies to enterovirus and Mycoplasma pneumoniae, or immune complex-bound antibodies to Chlamydia pneumoniae, significantly increased coronary event risk in men without baseline heart disease.
- This increased risk remained significant after adjusting for other antibodies and conventional risk factors.
- Serological evidence of multiple infections was also associated with a higher risk of coronary events.
Conclusions:
- Serological evidence of certain infections is linked to coronary heart disease risk.
- This association is specifically observed in men without a prior history of heart disease.
- Infectious agents may play a role in the development of CHD in previously healthy individuals.
Objectives:
To study antibodies against five infectious agents for their prediction of major coronary events in men with and without evidence of coronary heart disease at baseline.
Design:
A case-control study nested within a prospective population study.
Subjects:
The study cases included 441 men 45-64 years old with nonfatal myocardial infarction or coronary death within a mean follow-up time of 10 years. A total of 165 men had already signs of heart disease at baseline, whilst 276 were apparently healthy at the beginning of the study. Two controls for each case were matched for age, heart disease status and place of residence. Antibodies against enterovirus, Mycoplasma pneumoniae, Chlamydia pneumoniae, cytomegalovirus and adenovirus were determined.
Results:
Men without reported baseline heart disease, but not those with heart disease, showing the highest quartile of antibodies to enterovirus and mycoplasma or increased levels of immune complex-bound antibodies to chlamydia had a significantly higher risk of coronary events than men with lower level of antibodies. The increased risk demonstrated in men with high levels of antibodies to enterovirus and mycoplasma remained significant after adjustment for other antibodies, acute-phase reactant and conventional risk factors. Serological evidence of infection by multiple agents was also significantly associated with coronary events.
Conclusions:
Serological evidence for several infectious agents is associated with the risk of coronary heart disease, but only in men without baseline history of heart disease.