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Published on: November 20, 2015
Infections in early life and premature acute coronary syndrome: A case-control study
Andriany Qanitha1, Bastianus Ajm de Mol2, Dara R Pabittei3
1Department of Cardio-thoracic Surgery, Academic Medical Centre, University of Amsterdam, the Netherlands Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia a.qanitha@amc.uva.nl.
Insights
Childhood infections significantly increase the risk of developing premature coronary heart disease in adulthood. Early life infections may also amplify the effects of traditional cardiovascular risk factors.
Area of Science:
- Cardiovascular Science
- Infectious Disease Epidemiology
- Public Health
Background:
- Childhood infections can impact vasculature and initiate early atherosclerosis.
- The link between childhood infections and adult cardiovascular disease is not well understood.
- This study investigates the association between early life infections and premature coronary heart disease.
Purpose of the Study:
- To determine if infections experienced in early life are associated with the occurrence of premature coronary heart disease.
- To explore the potential role of early life infections in the development of adult cardiovascular disease.
Main Methods:
- A population-based case-control study involving 153 young acute coronary syndrome (ACS) patients and 153 matched controls.
- Data collected included history of severe childhood/adolescent infections, clinical/laboratory measurements, and cardiovascular risk factors.
- An infection score was developed to quantify the burden of early life infections; conditional logistic regression was used for analysis.
Main Results:
- Early life infections were associated with a 2.67-fold increased risk of young-onset acute coronary syndrome (ACS).
- This association remained significant after adjusting for traditional risk factors, lifestyle, and socio-economic status.
- An interaction was observed between early life infections and current cardiovascular risk (Framingham Risk Score), with risk escalating significantly at intermediate and high FRS levels.
Conclusions:
- Infections during early life may contribute to premature coronary heart disease in adulthood.
- Early life infections might potentiate the effects of traditional cardiovascular risk factors, highlighting a potential public health concern.
Background:
Infections in young children may affect the vasculature and initiate early atherosclerosis. Whether infections experienced in childhood play a part in adult clinical cardiovascular disease remains unclear. We investigated the association between infections in early life and the occurrence of premature coronary heart disease.
Methods:
We conducted a population-based case-control study of 153 patients with a first acute coronary syndrome before the age of 56 years and 153 age- and sex-matched controls. Any history of severe infections in childhood and adolescence was obtained, together with clinical and laboratory measurements and other cardiovascular risk factors. We developed an infection score for the overall burden of early life infections. Conditional logistic regression was used to assess the associations.
Results:
Infections experienced in early life increased the risk of acquiring acute coronary syndrome at a young age with an odds ratio (OR) of 2.67 (95% confidence interval (CI) 1.47-4.83, p = 0.001). After adjustments for traditional risk factors, lifestyle, dietary patterns, socio-economic status and parental history of cardiovascular events, these associations remained significant and changed only slightly. There was an indication for an interaction between infections in early life and current cardiovascular risk (Framingham Risk Score (FRS); p-interaction = 0.052). Within participants with a low FRS (<10%), the OR of early life infection for acute coronary syndrome was 1.49 (95% CI 0.72-3.08, p = 0.283); within participants with an intermediate FRS (10-20%), the OR was 4.35 (95% CI 1.60-11.84, p = 0.004); and within participants with a high FRS (>20%), the OR 10.00 (95% CI 1.21-82.51, p = 0.032).
Conclusion:
Infections in early life may partly explain premature coronary heart disease in adulthood and may potentiate traditional cardiovascular risk factor effects.
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