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Published on: April 7, 2015
Chronic infections & coronary artery disease with special reference to Chalmydia pneumoniae
S Padmavati1, U Gupta, H K Agarwal
1All India Heart Foundation, New Delhi, India. padmavat@vsnl.com
Insights
This study investigated infections as a cause of coronary artery disease (CAD). No direct link was found between Chlamydia pneumoniae and CAD, though some infections may indirectly affect lipid profiles.
Area of Science:
- Cardiology
- Infectious Diseases
- Biochemistry
Background:
- Cardiovascular diseases (CVD) in India present a significant burden, with a notable percentage of cases lacking identifiable risk factors.
- This suggests a potential, yet understudied, role for infections in the etiology of CVD.
- Limited data exists on the association between specific infections and coronary artery disease (CAD).
Purpose of the Study:
- To investigate the potential association between infections, specifically Chlamydia pneumoniae and other pathogens, and the development of coronary artery disease (CAD).
- To explore the role of infectious agents in cases of acute myocardial infarction (AMI) and in patients undergoing coronary artery bypass graft (CABG) surgery.
Main Methods:
- Patients were categorized into acute myocardial infarction (AMI), coronary artery bypass graft (CABG) surgery, and control groups.
- Comprehensive testing included routine blood work, inflammatory markers (CRP, TLC, fibrinogen, ESR), and serological tests for antibodies (IgA, IgG) against various pathogens (C. pneumoniae, H. pylori, CMV, M. pneumoniae, Parvovirus B-19) using ELISA.
- Chlamydia pneumoniae antigen detection via microimmunofluorescence and PCR on endothelial tissue from CABG patients, along with aortic punch biopsies, were performed.
Main Results:
- While AMI patients showed higher associations with traditional cardiac risk factors and inflammatory markers, IgG and IgA antibody levels against C. pneumoniae did not differ significantly between AMI and control groups.
- A significant association was observed between C. pneumoniae antigen positivity and specific lipid parameters, including HDL cholesterol, lipid tetrad index, and triglycerides.
- Parvovirus B antigen was detected in 8.3% of tissue specimens by PCR, and 6.8% of AMI patients tested positive for parvovirus B-19 IgG antibodies.
Conclusions:
- The study found no direct evidence implicating Chlamydia pneumoniae or other examined infective agents and viruses in the direct causation of coronary artery disease (CAD).
- However, the findings suggest a potential indirect influence of such infections on the lipid profile, which warrants further investigation.
Background & Objectives:
Studies on cardiovascular diseases (CVD) in India have shown about 10-20 per cent of cases with no obvious risk factors, raising a suspicion of infections as a cause. There is a paucity of data on this possible role of infections. This study was, therefore, undertaken to find out the association between infection due to Chlamydia pneumoniae and other organisms and coronary artery disease (CAD).
Methods:
Patients with CAD were selected in group I (acute myocardial infarction, AMI) and group III (patients undergoing coronary artery bypass graft (CABG) surgery), and normal controls in group II. Routine biochemical, haematological and inflammatory tests [C-reactive protein (CRP), total leucocyte count (TLC), fibrinogen, ESR], serodiagnostic tests for IgA and IgG antibodies to C. pneumoniae, Helicobacter pylori, cytomegalovirus (CMV), Mycoplasma pneumoniae and Parvovirus B-19 by ELISA kits, C. pneumoniae antigen by microimmunofluorescence and PCR from endothelial tissue obtained at CABG were carried out. Aortic punch biopsies were done in patients who underwent CABG.
Results:
Acute MI patients had a significantly higher association with accepted cardiac risk factors, lipid profile, inflammatory and thrombogenic tests. IgG and IgA antibodies levels against C. pneumoniae were not significantly different in the controls as against the AMI group. However, C. pneumoniae antigen seropositive group had significant association with HDL cholesterol, lipid tetrad index (P<0.001) and with triglycerides. Parvovirus B antigen was detected in 8.3 per cent of tissue specimens by PCR and of 44 patients with AMI (6.8%) were also positive for parvovirus B-19 IgG antibodies.
Interpretation & Conclusions:
There was no direct evidence of the involvement of C. pneumoniae and other infective agents and viruses in CAD. It is possible that such infections produce an indirect adverse effect on the lipid profile.
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