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Pathogen burden, cytomegalovirus infection and inflammatory markers in the risk of premature coronary artery disease in individuials of Indian origin
Experimental and Clinical Cardiology, 07/17/2012
Mundkur LA et al. – Pathogen burden, especially cytomegalovirus (CMV) infection in combination with inflammatory markers, is a significant predictor of coronary artery disease (CAD) risk in the young Indian population.
Methods- Antibody titres for Chlamydia pneumoniae, cytomegalovirus (CMV), Helicobacter pylori, herpes simplex virus and levels of interleukin–6 (IL–6), high–sensitivity C–reactive protein (hsCRP), fibrinogen and secretory phospholipase A2, were measured in 866 individuals (433 CAD patients and matched controls).
- All individuals were followed–up for recurrent cardiac events for four years.
- ANOVA was used to study the association of infection and inflammation with CAD.
- The present study found that the odds of CAD occurrence was 2.42 (95% CI 1.26 to 4.64; P<0.008), with all four infections and increased in the presence of hsCRP (OR 4.67 [95% CI 1.43 to 15.25]); P=0.011).
- Only anti–CMV antibody levels were a significant risk factor for CAD occurrence (OR 2.23 [95% CI 1.20 to 4.15]; P=0.011) and recurrent cardiac events (OR 1.94 [95% CI 0.85 to 4.45]; P=0.015).
- Mean values of the inflammatory biomarkers IL–6 (P=0.035), fibrinogen (P=0.014), hsCRP (P=0.010) and secretory phospholipase A2 (P=0.002) increased with CMV antibody levels.
- Incorporating hsCRP and IL–6 in the risk prediction models significantly increased the OR to 2.56 (95% CI 1.16 to 5.63; P=0.019) with a c statistic of 0.826.