Dual role of infections as risk factors for coronary heart disease

Pesonen, Erkki; Andsberg, Eva; Öhlin, Hans; Puolakkainen, Mirja; Rautelin, Hilpi; Sarna, Seppo; Persson, Kenneth

doi:10.1016/j.atherosclerosis.2006.05.018

Cited by 25 publications

(36 citation statements)

References 37 publications

(38 reference statements)

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“…Cases consisted of 264 male patients, who were admitted for ACS to the CICU in Lund University Hospital between March 1999 and April 2002, as described in detail earlier (9). The 238 controls were selected from the same suburbs, as the patients and the groups were matched with age G2 years.…”

Section: Study Population and Diagnosesmentioning

confidence: 99%

“…Testosterone was measured using Spectria RIA kits (Orion Diagnostica, Turku, Finland). The intra-and inter-assay coefficients of The following viral and bacterial antibody titers, as reported in our earlier articles (9,10), were used in statistical analyses: Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, Herpes simplex virus, enterovirus (9), Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis (10).…”

Section: Laboratory Determinationsmentioning

confidence: 99%

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Adaptation to acute coronary syndrome-induced stress with lowering of testosterone: a possible survival factor

Pesonen

Pussinen

Huhtaniemi

2016

European Journal of Endocrinology

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Objective: The objective of this study was to explore whether circulating testosterone (T) concentration is associated with the occurrence and risk for acute coronary syndromes (ACS). Method: This case-control study included male patients with acute myocardial infarction (AMI) (nZ174) or unstable angina pectoris (UAP) (nZ90) and healthy controls (nZ238). Patients gave serum samples during the acute (nZ264) and recovery (nZ132) phases after a median of 10.5 months after the incident event. Secondary events (ACS or cardiovascular death) were registered during the following 6 years. Results: During the acute phase, AMI and UAP patients had similar significantly reduced concentrations of serum testosterone in comparison to controls. Testosterone associated inversely with weight, the degree of inflammation (i.e. C-reactive protein concentration) and signs of a chronic infection. In a multiadjusted Cox regression, when compared to testosterone concentrations considered high-normal (14.91-34.0 nmol/l), low-normal testosterone (9.26-14.90 nmol/l) in the acute phase predicted better prognosis for cardiovascular death rate with a hazard ratio (HR) of 0.17 (0.04-0.68, PZ0.012). The increased testosterone concentrations after the recovery period did not associate with future cardiovascular disease events. Conclusion: Low-normal testosterone levels in the acute phase of ACS predicted better survival. The observation may indicate better adaptation to stress in survivors and warrants further study.

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Section: Study Population and Diagnosesmentioning

confidence: 99%

Section: Laboratory Determinationsmentioning

confidence: 99%

Adaptation to acute coronary syndrome-induced stress with lowering of testosterone: a possible survival factor

Pesonen

Pussinen

Huhtaniemi

2016

European Journal of Endocrinology

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“…Cases consisted of 343 patients, 270 men and 73 women, who were admitted for ACS to the heart intensive care unit in Lund University Hospital between March 1999 and April 2002 as described earlier in detail [14]. Of the invited patients, 21 died before they could be interviewed and 48 chose not to participate.…”

Section: Subjectsmentioning

confidence: 99%

“…The details of the methodology of Chlamydia pneumoniae heat shock protein 60 (CpnHSP60) and human heat shock protein 60 (HHSP60) IgA and IgG, and high sensitive Creactive protein (CRP) and serum amyloid A (SAA) are reported earlier [14].…”

Section: Laboratory Determinationsmentioning

confidence: 99%

The balance of serum matrix metalloproteinase-8 and its tissue inhibitor in acute coronary syndrome and its recurrence

Pussinen

Sarna

Puolakkainen

et al. 2013

International Journal of Cardiology

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The balance of serum matrix metalloproteinase-8 and its tissue inhibitor in acute coronary syndrome and its recurrence Pussinen, Pirkko J.; Sarna, Seppo; Puolakkainen, Mirja; Öhlin, Hans; Sorsa, Timo; Pesonen, Erkki Citation for published version (APA): Pussinen, P. J., Sarna, S., Puolakkainen, M., Öhlin, H., Sorsa, T., & Pesonen, E. (2013). The balance of serum matrix metalloproteinase-8 and its tissue inhibitor in acute coronary syndrome and its recurrence. International Journal of Cardiology, 167(2), 362-368. https://doi.org/10.1016/j.ijcard.2011.12.095 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. AbstractBackground Matrix metalloproteinase-8 (MMP-8) is involved in the breakdown of the extracellular matrix increasing the vulnerability of atherosclerotic lesions. We analyzed the diagnostic value of serum MMP-8 and tissue inhibitor of metalloproteinase-1 (TIMP-1) concentrations in acute coronary syndrome (ACS) and their prognostic value in ACS recurrence. MethodsThe population comprised 343 patients with ACS [including 108 unstable angina pectoris and 235 acute myocardial infarctions (AMI)] and 326 healthy controls. Additionally, 157 (45.8%) patients were resampled during the recovery. The ACS patients were followed up for 6 years.Results MMP-8, TIMP-1, and their molar ratio distinguished the cases from the controls; C-statistic of the multivariate model (95% CI, p-value) including the MMP-8/TIMP-1 ratio regarding its discriminating ability for AMI was 0.922 (0.893-0.950, p<0.001). After the acute phase of ACS, median MMP-8 and TIMP-1 concentrations decreased (p<0.001) by 34.5 and 28.7%, respectively, but ended up on a different level than those found in the controls. In the follow-up, acute phase and recovery period TIMP-1 concentrations associated with cardiovascular death with hazard ratios 4.31 (2.00-9.26, p<0.001) and 4.69 (1.10-20.01, p=0.037), respectively. ConclusionsThe increase of serum MMP-8 and TIMP-1 concentrations may reflect plaque instability and tissue damage. TIMP-1 concentrations are associated with poor outcome in patients with ACS. The findings may have practical implications in both diagnostics and therapeutics.

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“…In addition, periodontal diseases and high antibody response to major periodontal pathogens are associated with coronary heart disease and myocardial infarction [Pussinen et al 2005[Pussinen et al , 2004Mattila et al 1989]. Moreover, infectious burden, elevated antibody titres to many infectious agents, is associated with an increased risk of acute coronary syndromes (ACS) [Pesonen et al 2007;Espinola-Klein et al 2002]. More unclear is whether infections are chronic stimuli for the development of atherosclerosis or whether acute infections might have a special role in precipitating final clinical events, the ACS.…”

Section: Introductionmentioning

confidence: 99%

Infections as a stimulus for coronary occlusion, obstruction, or acute coronary syndromes

Pesonen

El-Segaier

Persson

et al. 2009

Therapeutic Advances in Cardiovascular Disease

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Abstract:Background: Atherosclerosis is considered to be an inflammatory disease. Infections are a significant cause of inflammation. Acute infections might precipitate acute coronary syndromes (ACS) whereas chronic infections might be stimuli for the development of atherosclerosis. Methods: Coronary angiograms were done on 211 of 335 patients with ACS and the percentage of coronary obstruction was determined. Serum antibody levels to Chlamydia pneumoniae, C. pneumoniae heat shock protein 60 (CpnHSP60), human heat shock protein 60 (hHSP60), enterovirus (EV), herpes simplex virus (HSV), cytomegalovirus (CMV), and two major periodontal pathogens, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, were measured in healthy controls (n ¼ 355) and all patients. Results: Serum antibody levels to periodontal pathogens did not correlate with ACS. However, IgA-class antibody levels to Aggregatibacter actinomycetemcomitans (p ¼ 0.021), CpnHSP60 (p ¼ 0.048) an hHSP60 (p ¼ 0.038) were higher in patients with coronary occlusion or obstruction compared to those without any obstruction. Odds ratios for coronary changes in the highest quartile as compared to the lower quartiles were for A. actinomycetemcomitans IgA 7.84 (95% CI 1.0260.39, p ¼ 0.048), for CpnHSP60 IgA 8.61 (1.1265.89, p ¼ 0.038), and for human HSP60 IgA 3.51 (0.7915.69, p ¼ 0.100). Conclusions: We have previously reported that EV and HSV titres correlated significantly to acute coronary events. They do not correlate to the degree of coronary obstruction as shown here. However, infection by A. actinomycetemcomitans or C. pneumoniae or host response against them associated with coronary obstruction. Clinical coronary events may arise by the effect of acute infections and obstructing lesions by a chronic inflammatory stimulus.

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Dual role of infections as risk factors for coronary heart disease

Abstract: Childhood contagious diseases (n=6) had a protecting effect against CHD (odds ratio 0.86, p=0.013). The risk for acute coronary events decreased significantly with increasing number of childhood contagious diseases (p=0.007).Conclusions. Infections have a dual role in the genesis of CHD.

Cited by 25 publications

References 37 publications

Adaptation to acute coronary syndrome-induced stress with lowering of testosterone: a possible survival factor

Adaptation to acute coronary syndrome-induced stress with lowering of testosterone: a possible survival factor

The balance of serum matrix metalloproteinase-8 and its tissue inhibitor in acute coronary syndrome and its recurrence

Infections as a stimulus for coronary occlusion, obstruction, or acute coronary syndromes

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