Relation of Chlamydia pneumoniae serology to mortality and incidence of ischaemic heart disease over 13 years in the Caerphilly prospective heart disease study   Commentary: Chlamydia pneumoniae infection and ischaemic heart disease

Strachan, D. P.; Carrington, David; Mendall, M. A.; Ballam, Lydia; Morris, Julia E.; Butland, B. K.; Sweetnam, P. M.; Elwood, Peter Creighton; West, Roy

doi:10.1136/bmj.318.7190.1035

Cited by 124 publications

(66 citation statements)

References 31 publications

(40 reference statements)

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“…25,26 In most but not all seroepidemiological evaluations, subjects with a prominent immune response to C pneumoniae or (virulent strains of) H pylori, as indicative of chronic infection status, faced an excess risk of coronary heart disease, stroke, and vascular death. 7,[13][14][15][27][28][29] Finally, chronic bronchitis, as defined by self-reported clinical symptoms, and periodontal disease have LR denotes likelihood ratio. ORs were derived from multiple stepwise logistic regression analysis.…”

Section: Discussionmentioning

confidence: 99%

Chronic Infections and the Risk of Carotid Atherosclerosis

et al. 2001

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Background-Chronic infections have been implicated in the pathogenesis of atherosclerosis, yet from an epidemiological perspective, this concept remains controversial. Methods and Results-The Bruneck Study is a prospective population-based survey on the pathogenesis of atherosclerosis.In 826 men and women 40 to 79 years old (1990 baseline), 5-year changes in carotid atherosclerosis were thoroughly assessed by high-resolution duplex scanning. The presence of chronic respiratory, urinary tract, dental, and other infections was ascertained by standard diagnostic criteria. Chronic infections amplified the risk of atherosclerosis development in the carotid arteries. The association was most pronounced in subjects free of carotid atherosclerosis at baseline (age-/sex-adjusted odds ratio [95% CI] for any chronic infection versus none, 4.08 [2.42 to 6.85]; PϽ0.0001) and applied to all types of chronic (bacterial) infections. It remained independently significant after adjustment for classic vascular risk attributes and extended to low-risk individuals free of conventional risk factors. Among subjects with chronic infections, atherosclerosis risk was highest in those with a prominent inflammatory response. Markers of systemic inflammation, such as soluble adhesion molecules and circulating bacterial endotoxin, and levels of soluble human heat-shock protein 60 and antibodies to mycobacterial heat-shock protein 65 were elevated in subjects with chronic infections and predictive of an increased risk of atherosclerosis. Conclusions-The present study provides solid evidence for a role of common chronic infections in human atherogenesis.Induction of systemic inflammation and autoimmunity may be potential pathophysiological links.

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Section: Discussionmentioning

confidence: 99%

Chronic Infections and the Risk of Carotid Atherosclerosis

et al. 2001

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“…[5][6][7][8][9][10][11][12][13][14][15][16] However, recent reports from several prospective studies failed to demonstrate consistent associations between the presence of IgG antibodies to C pneumoniae, HSV-1, and CMV and incident MI. [17][18][19][20][21][22] Given both the high prevalence of IgG antibodies to these agents and the high incidence of cardiovascular disease among older adults, it is particularly important to determine whether serological evidence of prior infection with these agents, assessed late in life, is associated with incident MI and CHD death. We examined this question in an ancillary study to the Cardiovascular Health Study (CHS), a cohort study of men and women aged Ն65 years.…”

Section: T He Role Of Viruses and Other Infectious Agents Such Asmentioning

confidence: 99%

Chlamydia pneumoniae , Herpes Simplex Virus Type 1, and Cytomegalovirus and Incident Myocardial Infarction and Coronary Heart Disease Death in Older Adults

et al. 2000

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Background-Whether serological evidence of prior infection with Chlamydia pneumoniae, herpes simplex virus type 1 (HSV-1), and cytomegalovirus (CMV) is associated with myocardial infarction (MI) and coronary heart disease (CHD) death remains a source of controversy. Methods and Results-We conducted a nested case-control study among participants in the Cardiovascular Health Study, a cohort study of persons aged Ն65 years. Cases experienced an incident MI and CHD death (nϭ213). Control subjects were matched to cases by age, sex, clinic, year of enrollment, and month of blood draw (nϭ405). Serum was analyzed for IgG antibodies to C pneumoniae, HSV-1, and CMV. After adjustment for other risk factors, the risk of MI and CHD death was associated with the presence of IgG antibodies to HSV-1 (odds ratio [OR] 2.0, 95% CI 1.1 to 3.6) but was not associated with the presence of IgG antibodies to either C pneumoniae (OR 1.1, 95% CI 0.7 to 1.8) or CMV (OR 1.2, 95% CI 0.7 to 1.9). Although there was little association with low to moderate C pneumoniae antibody titers (Յ1:512), high-titer (1:1024) C pneumoniae antibody was associated with an increased risk (OR 2.2, 95% CI 1.1 to 4.4). Conclusions-Among older adults, the presence of IgG antibodies to HSV-1 was associated with a 2-fold increase in the risk of incident MI and CHD death. For C pneumoniae, only high-titer IgG antibodies were associated with an increased risk of MI and CHD death. The presence of IgG antibodies to CMV was not associated with risk among the elderly.

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“…An association between immunoglobulin A (IgA), but not IgG, antibodies to C. pneumoniae and the subsequent risk of death from ischemic heart disease, the risk of ischemic stroke, and the severity of arteriosclerosis of carotid or femoral arteries has been found (23,64,96). In patients undergoing carotid endarterectomy, the plaques were investigated for C. pneumoniae and the blood was examined for antichlamydial antibodies.…”

Section: Infectious Pathogens (I) Helicobacter Pylorimentioning

confidence: 99%