Productive Cytomegalovirus Infection Is Associated With Impaired Endothelial Function in ST-Elevation Myocardial Infarction

Abstract

BACKGROUND: An association between productive cytomegalovirus infection and atherosclerosis was shown recently in several trials, including a previous study of ours. However, the mechanism involved in this association is still under investigation. Here, we addressed the interaction between productive cytomegalovirus infection and endothelial function in patients with ST-elevation myocardial infarction (STEMI). METHODS: We analyzed the presence of cytomegaloviral DNA in plasma and endothelial function in 33 patients with STEMI and 33 volunteers without cardiovascular diseases, using real-time polymerase chain reaction (PCR) and a noninvasive test of flow-mediated dilation. RESULTS: Both the frequency of presence and the load of cytomegaloviral DNA were higher in plasma of patients with STEMI than those in controls. This difference was independent of other cardiovascular risk factors (7.38 [1.36-40.07]; P = 0.02). The results of the flow-mediated dilation test were lower in patients in STEMI than in controls (5.0% [2.65%-3.09%] vs 12. %5 [7.5%-15.15%]; P = 0.004) and correlated negatively with the cytomegaloviral DNA load (Spearman R = À0.407; P = 0.019) independently of other cardiovascular risk factors. CONCLUSIONS: Productive cytomegalovirus infection in patients with STEMI correlated negatively with endothelial function independently of other cardiovascular risk factors. The impact of cytomegalovirus on endothelial function may explain the role of cytomegalovirus in cardiovascular prognosis. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. (http:// creativecommons.org/licenses/by-nc-nd/4.0/) The American Journal of Medicine (2020) 133:133−142

Abdominal aortic aneurysm and virus infection: A potential causative role for cytomegalovirus infection?

“…Furthermore, we found that the presence of CMV infection in patients with AAA was associated with an increased risk of hypertension and CAD. Numerous studies have reported an association of CMV and the pathogenesis of various cardiovascular diseases, such as atherosclerosis, CAD, and myocardial infarction, [34][35][36] whereas the link with hypertension remains unclear. [37][38][39][40][41][42][43] It was found that high CMV antibody titers were associated with elevated systolic blood pressure and hypertension.…”

The Role of CMV Infection in Primary Lesions, Development and Clinical Expression of Atherosclerosis

“…CMV direct detection by DNA or antigen identification strongly associates viral infection with atherosclerosis and cardiovascular disease as an end-point. Recent studies showed a higher viral load in STEMI patients compared to controls [21] and a direct relationship between T cells activation and the number of CMV-DNA copies inside the atherosclerotic plaques in patients with peripheral artery disease [22]. A higher number of CMV-DNA copies were detected in patients with preexistent cardiovascular risk factors and were associated to acute coronary syndrome, suggesting that CMV reactivation may lead to the progression of atherosclerotic lesions, for example, transforming stable angina into unstable angina or myocardial infarction [23].…”

Novel Strategies to Combat CMV-Related Cardiovascular Disease

“…We found a significantly higher frequency of presence and load of CMV DNA in patients with acute myocardial infarction than in controls [ 138 ]. Furthermore, when we assessed endothelial function in these patients, we for the first time showed a significant negative correlation between CMV DNA in plasma and the results of the FMD test in patients with acute myocardial infarction [ 139 ].…”