151
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Agmon Y, Khandheria BK, Meissner I, Petterson TM, O'Fallon WM, Christianson TJH, Wiebers DO, Smith TF, Steckelberg JM, Tajik AJ. Lack of association between Chlamydia pneumoniae seropositivity and aortic atherosclerotic plaques: a population-based transesophageal echocardiographic study. J Am Coll Cardiol 2003; 41:1482-7. [PMID: 12742286 DOI: 10.1016/s0735-1097(03)00261-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The objective of this study was to examine the relationship between Chlamydia pneumoniae seropositivity and aortic atherosclerotic plaques in the general population. BACKGROUND Seroepidemiologic studies suggest that C pneumoniae infection plays a role in the pathogenesis of atherosclerosis. METHODS Transesophageal echocardiography was performed in 385 subjects (median age 66 years, range 51 to 101 years; 53% men), a sample of the Olmsted County (Minnesota) population. The association between C pneumoniae immunoglobulin (Ig) G antibody titers and aortic atherosclerotic plaques was examined. RESULTS Chlamydia pneumoniae IgG antibodies (titers >or=1:16) were detected in 287 subjects (74.5%): low titers (1:16 to 1:32) in 58 (15.1%), intermediate titers (1:64 to 1:128) in 144 (37.4%), and high titers (>or=1:256) in 85 subjects (22.1%). Antibody titers were not associated with the presence of aortic plaques after adjustment for age, gender, and smoking status (p = 0.64). Compared with titers <1:16, the adjusted odds ratios for aortic plaques were 1.46 (95% confidence interval [CI] 0.63 to 3.42) for low titers, 1.32 (95% CI 0.68 to 2.55) for intermediate titers, and 0.94 (95% CI 0.42 to 2.07) for high titers. Among the subgroup with plaques, antibody titers were not associated with the presence of plaques >or=4 mm thick (p = 0.99), plaques >or=6 mm (p = 0.49), or mobile debris (p = 0.71), after adjustment for age and smoking. CONCLUSIONS Chlamydia pneumoniae IgG antibody titers are not associated with the presence or severity of aortic atherosclerosis in the general population. These observations do not support a role for C pneumoniae infection in the initiation or progression of atherosclerosis.
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Affiliation(s)
- Yoram Agmon
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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152
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Abstract
The observation that almost half of all myocardial infarctions and strokes occur in persons without elevated levels of low-density lipoprotein cholesterol has prompted the study of factors other than hyperlipidemia that contribute to the development of atherosclerosis. A growing body of evidence indicates that inflammation plays a substantial role in plaque progression and rupture. Research interest has increasingly focused on biomarkers of inflammation as a means of predicting more accurately which patients are at high risk for cardiovascular disease (CVD). Clinical studies indicate that C-reactive protein (CRP), a marker of systemic inflammation, independently predicts cardiovascular risk in healthy persons as well as in persons with established CVD and those with acute ischemia. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, have been shown to reduce levels of CRP through mechanisms independent of their effects on lipid levels. Initial clinical studies also suggest that CRP levels may have utility in the targeting of statin therapy, particularly in primary prevention. These results need direct testing in large, prospective clinical trials to determine whether statin therapy will benefit persons without overt hyperlipidemia but with evidence of systemic inflammation. Confirmation of these preliminary findings, if incorporated into evidence-based guidelines, may profoundly change the approach to diagnosis and treatment of CVD.
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Affiliation(s)
- Paul M Ridker
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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153
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Witherell HL, Smith KL, Friedman GD, Ley C, Thom DH, Orentreich N, Vogelman JH, Parsonnet J. C-reactive protein, Helicobacter pylori, Chlamydia pneumoniae, cytomegalovirus and risk for myocardial infarction. Ann Epidemiol 2003; 13:170-7. [PMID: 12604160 DOI: 10.1016/s1047-2797(02)00276-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE C-reactive protein (CRP), Chlamydia pneumonia, Helicobacter pylori, and cytomegalovirus (CMV) have each been associated with atherosclerosis. We assessed how infection and CRP related to risk for subsequent myocardial infarction (MI). METHODS Using a nested case-control design, we assessed how these factors independently and jointly affected risk for myocardial infarction (MI). Cases of first MI (N = 121) were identified from among participants in a multiphasic health check-up cohort. Controls without MI (N = 204) were matched to cases by gender, age, race, and date of serum collection. Sera collected at enrollment were tested for antibodies to infection and for CRP. RESULTS In multivariate analysis (mean follow-up of 5.1 years), CRP was associated with MI only in subjects older than 51 years (p = 0.004). Although H. pylori infection increased risk for MI, this association was modest (OR = 1.90, 95% CI = 0.97-3.71) and was not evident in non-smokers or when adjusted for education. No association between C. pneumoniae or cytomegalovirus and MI was observed, nor was the association between CRP and MI explained by these infections. CONCLUSIONS Elevated CRP is a risk factor for subsequent MI in older individuals. The relationship between Hp and MI may be due to confounding or co-linearity with socioeconomic status.
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Affiliation(s)
- Heidi L Witherell
- Department of Medicine, Stanford University School of Medicine, CA 94305, USA
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154
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van der Ven A, van Diest R, Hamulyák K, Maes M, Bruggeman C, Appels A. Herpes viruses, cytokines, and altered hemostasis in vital exhaustion. Psychosom Med 2003; 65:194-200. [PMID: 12651986 DOI: 10.1097/01.psy.0000058378.50240.80] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Infections with herpes viruses have been implicated in the pathogenesis of atherosclerosis. We tested the hypothesis that vital exhaustion (VE) is associated with multiple herpesvirus infections, such as herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus, and with an increase in pathogen burden (ie, the aggregated seropositivity to immunoglobulin G antibodies for herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus). In addition, we examined the association of VE and pathogen burden with measures of hemostasis and inflammation. METHODS Blood samples were drawn from 29 men with VE and 30 male control subjects, all healthy and nonsmokers, to assess serological evidence of infection and measures of hemostasis and inflammation. RESULTS VE is associated with a relatively high pathogen burden, altered hemostasis, and higher levels of cytokines, such as interleukin-6. Across all subjects, a relatively high pathogen burden was also associated with altered hemostasis but not with increased cytokine levels. The interaction of VE with pathogen burden revealed significant linear increases in measures of hemostasis and inflammation. Finally, immunoglobulin G antibody titer levels of individual herpesvirus infections were not associated with hemostatic measures or with cytokines. CONCLUSIONS We conclude that stress-related alterations in hemostasis and inflammation are not necessarily linked to one particular herpesvirus infection but rather to an increase in aggregated seropositivity to herpesvirus infections.
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Affiliation(s)
- Andre van der Ven
- Department of Medical Microbiology, Maastricht University, Maastricht, The Netherlands
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155
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Gerdes VEA, Verkooyen RP, Kwa VIH, de Groot E, van Gorp ECM, ten Cate H, Brandjes DPM, Büller HR. Chlamydial LPS antibodies, intima-media thickness and ischemic events in patients with established atherosclerosis. Atherosclerosis 2003; 167:65-71. [PMID: 12618269 DOI: 10.1016/s0021-9150(02)00150-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chlamydia pneumoniae has been associated with cardiovascular disease. However, studies on the presence of chlamydial antibodies and intima-media thickness (IMT) or future ischemic events are inconclusive. We examined the relation between circulating antibodies to chlamydial lipopolysaccharide (cLPS Ab), IMT and the occurrence of ischemic events during follow-up in patients with manifest atherosclerotic disease. METHODS IgG and IgA antibodies against cLPS were determined in 273 out of 307 consecutive patients with a recent ischemic stroke (IS, n=90), a recent myocardial infarction (MI, n=87) or peripheral arterial disease (PAD, n=96). B-mode ultrasound IMT measurement of carotid and femoral arteries was performed and ischemic events, IS or MI, during follow-up were registered. RESULTS IgG and IgA were found in 66 and 46% of the patients, respectively. We did not detect any difference in IMT between patients with or without antibodies: IgA-0.97(0.28) mm versus IgA+0.95(0.26) mm, P=0.63, IgG-0.96(0.28) mm versus IgG+0.96(0.26) mm, P=0.98. During follow-up with a mean duration of 3.5 years the combined endpoint, MI or IS, was similar in patients with or without antibodies (IgA-24% vs. IgA+19%, IgG-23% vs. IgG+22%). However, a lower frequency of MI was observed in IgA positive patients (IgA-13% vs. IgA+8%). The number of ischemic events in the 12 patients who used anti-chlamydial antibiotics was similar compared with those who did not use antibiotics. CONCLUSION In patients with manifest atherosclerotic disease no association between the presence of cLPS Ab and IMT could be detected. In addition, no influence of cLPS Ab on the number of ischemic events was observed, the frequency of MI during follow-up in IgA positive patients was even lower.
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Affiliation(s)
- Victor E A Gerdes
- Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.
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156
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Angiolillo DJ, Liuzzo G, Pelliccioni S, De Candia E, Landolfi R, Crea F, Maseri A, Biasucci LM. Combined role of the Lewis antigenic system, Chlamydia pneumoniae, and C-reactive protein in unstable angina. J Am Coll Cardiol 2003; 41:546-50. [PMID: 12598063 DOI: 10.1016/s0735-1097(02)02899-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The goal of this study was to assess the prognostic role of the Lewis antigenic system, Chlamydia pneumoniae (CP) seropositivity (CP+), and C-reactive protein (CRP) levels in unstable angina (UA). BACKGROUND The role of CP infection in acute coronary syndromes is contradictory. The Lewis antigenic system, a genetically determined blood group system associated with infections and several disorders, including ischemic heart disease, might influence the susceptibility to CP infection, inflammatory response, and risk of cardiac ischemic events. METHODS The CRP levels, Lewis antigens, and CP+ were measured in 54 patients with Braunwald's class IIIB UA. All patients were followed up for one year, and the occurrence of new coronary events (coronary death, myocardial infarction, and recurrence of instability) were recorded. RESULTS Twenty-five coronary events occurred during follow-up. At univariate analysis CRP >3 mg/l (CRP+) (p = 0.0056), Lewis antigen b (Leb+) (p = 0.028), and the combination of Leb+ and CP+ (p = 0.006) and of CRP+ and Leb+ (p = 0.003) were associated with new coronary events, while CP+ alone was not. At multivariate analysis, CRP+ (p = 0.008) and combined Leb+CP+ (p = 0.03) were independent predictors of worse outcome. The event rate was 64% in CRP+ patients, 67% in Leb+CP+ patients, and 86% in CRP+Leb+CP+ patients. Combined Leb+CP+, but not Leb+ and CP+ alone, was related to CRP levels (p = 0.03). Among CP+ patients, CRP levels were higher in Leb+ than Leb- (p = 0.028). CONCLUSIONS Our data demonstrate that in UA the Lewis antigenic system plays an important role, probably determining individual susceptibility to the detrimental effects of CP infection and by determining an enhanced inflammatory response.
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Affiliation(s)
- Dominick J Angiolillo
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
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157
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Almagor M, Keren A, Banai S. Increased C-reactive protein level after coronary stent implantation in patients with stable coronary artery disease. Am Heart J 2003; 145:248-53. [PMID: 12595841 DOI: 10.1067/mhj.2003.16] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Elevation of C-reactive protein (CRP), among other markers of inflammation, is associated with an increased risk for cardiac events in patients with known coronary diseases and in apparently healthy individuals. Moreover, in patients with acute coronary syndromes, elevated serum levels of CRP are strongly predictive of the risk for death from cardiac causes. The purpose of this study was to investigate whether mechanical rupture of an atherosclerotic coronary plaque during elective stent implantation in patients with stable coronary artery disease (CAD) at low risk will cause a significant increase in serum levels of CRP. METHODS AND RESULTS We measured serum CRP levels in 40 patients. Group 1 consisted of 12 consecutive patients with stable coronary disease who were at low risk, before and after elective coronary stent implantation. We compared the results in these patients to those of patients in 2 control groups: group 2 consisted of 12 consecutive patients with non-ST-segment elevation acute coronary syndrome (NSTSE ACS) who were undergoing coronary stent implantation, and group 3 included 16 consecutive patients with stable or unstable CAD who were undergoing diagnostic coronary angiography only without PCI. Peripheral blood samples for CRP level testing were withdrawn before percutaneous coronary intervention or angiography at the completion of the procedure, and 6, 20, and 48 hours thereafter. All patients with stable CAD (group 1) had a significant and uniform increase in serum CRP levels after elective stent implantation. The low mean baseline serum CRP levels increased 4.9 +/- 4.1-fold 20 hours after coronary intervention (2.1 +/- 1.2 before, 7.9 +/- 3.4 after, P <.002). The baseline CRP level was much higher in the patients with unstable coronary syndromes (group 2). In this group, only a 2.1-fold increase in mean CRP level was observed after stent implantation (7.4 +/- 5.5 before, 14.1 +/- 9.6 after, P <.004). Also, the response in this group was less uniform when compared with that in the stable CAD group. By contrast, in patients undergoing diagnostic coronary angiography, the mean baseline CRP level was higher than in the patients in the group with stable CAD; however, the mean CRP after the procedure was not significantly elevated in this group (4.5 +/- 3.6 before, 5.5 +/- 3.7 20 hours after, P = not significant). CONCLUSIONS Mechanical disruption of an atherosclerotic coronary plaque during elective coronary stent implantation in patients with stable CAD who are at low risk causes a systemic inflammatory response expressed by marked elevation in CRP concentration.
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Affiliation(s)
- Miriam Almagor
- Division of Clinical Laboratories, Bikur Cholim Hospital, Jerusalem, Israel
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158
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Chia S, Ludlam CA, Fox KAA, Newby DE. Acute systemic inflammation enhances endothelium-dependent tissue plasminogen activator release in men. J Am Coll Cardiol 2003; 41:333-9. [PMID: 12535831 DOI: 10.1016/s0735-1097(02)02701-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate in vivo the effects of acute systemic inflammation on the endogenous fibrinolytic capacity in men. BACKGROUND Systemic inflammation and endogenous fibrinolysis play a major role in the pathogenesis of coronary artery disease. Although previous studies have shown impaired endothelium-dependent vasomotor function, the effects of inflammation on the endothelial release of the fibrinolytic factor tissue plasminogen activator (t-PA) are unknown. METHODS In a double-blind randomized placebo-controlled crossover trial, we administered a mild inflammatory stimulus, Salmonella typhi vaccine, or saline placebo to eight healthy men on two separate occasions. Six hours after vaccination, blood flow and plasma fibrinolytic variables were measured in both arms during intrabrachial infusions of bradykinin (40 to 1,000 pmol/min), acetylcholine (5 to 20 microg/min), and sodium nitroprusside (2 to 8 microg/min). RESULTS Compared with placebo, the S. typhi vaccination caused a rise in white cell count (11.1 +/- 0.5 x10(9)/l vs. 7.9 +/- 0.8 x10(9)/l; p = 0.004) and plasma interleukin-6 concentrations (6.9 +/- 1.4 pg/ml vs. 1.6 +/- 0.4 pg/ml; p = 0.01) in addition to a significant augmentation of t-PA antigen (45 +/- 9 ng/100 ml/min at peak dose vs. 24 +/- 8 ng/100 ml/min at peak dose; p = 0.016, analysis of variance) and activity (104 +/- 15 IU/100 ml/min vs. 54 +/- 12 IU/100 ml/min; p = 0.006, analysis of variance) release during bradykinin infusion. Forearm blood flow increased in a dose-dependent manner after bradykinin, acetylcholine and sodium nitroprusside infusions (p < 0.001), but this was unaffected by vaccination. CONCLUSIONS Our results showed that acute systemic inflammation augmented local forearm t-PA release in men, which suggests that acute inflammation may invoke a protective response by enhancing the acute endogenous fibrinolytic capacity in healthy men. Further studies are needed to clarify whether this response is impaired in patients with cardiovascular disease.
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Affiliation(s)
- Stanley Chia
- Cardiovascular Research, University of Edinburgh, Royal Infirmary of Edinburgh, United Kingdom.
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159
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Tornel Osorio P, Martínez Hernández P, Abellán Alemána J, Alfonso Canoa C. La proteína C reactiva como marcador del riesgo cardiovascular. HIPERTENSION Y RIESGO VASCULAR 2003. [DOI: 10.1016/s1889-1837(03)71352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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160
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Riccioni G, De Santis A, Cerasa V, Menna V, Di Ilio C, Schiavone C, Ballone E, D'Orazio N. Atherosclerotic plaque formation and risk factors. Int J Immunopathol Pharmacol 2003; 16:25-31. [PMID: 12578728 DOI: 10.1177/039463200301600104] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Atherosclerosis (AT) is a progressive disease characterized by the accumulation of lipids, fibrous materials, and mineral in the arteries. Although many generalized or systemic risk factors predispose to its development, AT affect various regions of the circulation preferentially and yields distinct clinical manifestations depending on the particular circulatory bed affected. The progression of AT is currently believed to involve the interaction of endothelium, monocytes, and leukocytes, as well as the influences of cytokines, oxidized lipoproteins, hypertension, tobacco use, dyslipidemia, homocystinemia, and genetic determinants.
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Affiliation(s)
- G Riccioni
- Unit of Human Nutrition, University G. D'Annunzio, School of Medicine, Chieti, Italy.
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161
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Abstract
The endothelium plays a key role in vascular homeostasis through the release of a variety of autocrine and paracrine substances, the best characterized being nitric oxide. A healthy endothelium acts to prevent atherosclerosis development and its complications through a complex and favorable effect on vasomotion, platelet and leukocyte adhesion and plaque stabilization. The assessment of endothelial function in humans has generally involved the description of vasomotor responses, but more widely includes physiological, biochemical and genetic markers that characterize the interaction of the endothelium with platelets, leukocytes and the coagulation system. Stable markers of inflammation such as high sensitivity C-reactive protein are indirect and potentially useful measures of endothelial function for example. Attenuation of the effect of nitric oxide accounts for the majority of what is described as endothelial dysfunction. This occurs in response to atherosclerosis or its risk factors. Much remains to be learned about the molecular and genetic pathophysiological mechanisms of endothelial cell abnormalities. However, pharmacological intervention with a growing list of medications can favorably modify endothelial function, paralleling beneficial effects on cardiovascular morbidity and mortality. In addition, several small studies have provided tantalizing evidence that measures of endothelial health might provide prognostic information about an individual patient's risk of subsequent events. As such, the sum of this evidence makes the clinical assessment of endothelial function an attractive surrogate marker of atherosclerosis disease activity. The review will focus on the role of nitric oxide in atherosclerosis and the clinical relevance of these findings.
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Affiliation(s)
- Todd J Anderson
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
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162
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Mattila K, Vesanen M, Valtonen V, Nieminen M, Palosuo T, Rasi V, Asikainen S. Effect of treating periodontitis on C-reactive protein levels: a pilot study. BMC Infect Dis 2002; 2:30. [PMID: 12475397 PMCID: PMC138813 DOI: 10.1186/1471-2334-2-30] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2002] [Accepted: 12/10/2002] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Periodontitis is associated with elevated levels of C-reactive protein and fibrinogen and it may be a coronary heart disease risk factor. We wanted to study if treatment of periodontitis can decrease the levels of these inflammatory markers. METHODS C-reactive protein and fibrinogen levels were measured in 35 patients (21 M, 14 F, mean age 50 years) with adult periodontitis, before and after treatment. RESULTS The median baseline C-reactive protein level in the patients was 1.05 mg/l and it decreased to 0.7 mg/l (p = 0.05) after periodontal treatment. Of the 30 patients who could be included in the analyses, 24 patients had a baseline level below 2 mg/l (the 95th percentile limit in Finland); 6 patients had levels higher than this. Elevation of the baseline C-reactive protein level or the magnitude of its decrease were not associated with severe form of periodontitis. The decrease in C-reactive protein levels was at least 50 % in 4/6 of those with elevated baseline levels, as compared with 3/24 of the rest of the patients (p = 0.016). No corresponding effect was observed in fibrinogen levels. CONCLUSIONS Periodontitis seems to increase C-reactive protein only in some individuals, presumably the ones reacting to it with a systemic inflammatory reaction. Periodontal treatment decreases C-reactive protein levels in these individuals and it may thus decrease their risk of coronary heart disease.
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Affiliation(s)
- Kimmo Mattila
- Department of Medicine, Divisions of Infectious Diseases and Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Marja Vesanen
- Institute of Dentistry, University of Helsinki, Finland
| | - Ville Valtonen
- Department of Medicine, Divisions of Infectious Diseases and Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Nieminen
- Department of Medicine, Divisions of Infectious Diseases and Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Timo Palosuo
- National Public Health Institute, Helsinki, Finland
| | - Vesa Rasi
- Finnish Red Cross Blood Transfusion service, Helsinki, Finland
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163
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Laaksonen R, Janatuinen T, Vesalainen R, Lehtimäki T, Elovaara I, Jaakkola O, Jokela H, Laakso J, Nuutila P, Punnonen K, Raitakari O, Saikku P, Salminen K, Knuuti J. High oxidized LDL and elevated plasma homocysteine contribute to the early reduction of myocardial flow reserve in healthy adults. Eur J Clin Invest 2002; 32:795-802. [PMID: 12423319 DOI: 10.1046/j.1365-2362.2002.01051.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Impairment of coronary blood flow reserve has been shown to be an early manifestation of atherosclerosis and coronary artery disease (CAD). We studied more closely the contribution of various risk factors on early deterioration of coronary function. MATERIALS AND METHODS Fifty-one young, apparently healthy adults, with normal or mildly elevated serum cholesterol levels but without other major risk factors for CAD, such as diabetes or hypertension, underwent positron emission tomography (PET) studies. Coronary flow reserve (CFR) was measured using O15-water. In addition to the classical risk factors, the role of several new risk indicators, such as low-density lipoprotein (LDL) oxidation, infection (Chlamydia pneumoniae antibodies), and inflammation parameters (adhesion molecules, ICAM, VCAM, selectin, and C-reactive protein), homocysteine and body iron stores were investigated. RESULTS Elevated lipid and lipoprotein levels were not associated with reduced coronary reactivity. However, high autoantibody titers against oxidized LDL (oxLDL) were associated with 21% lower CFR than low oxLDL (P < 0.05). Furthermore, high homocysteine levels predicted low CFR (P < 0.05). The other measured parameters, Chlamydia pneumoniae antibody levels, C-reactive protein and adhesion molecule concentrations did not associate with myocardial blood flow. In a stepwise regression model, oxLDL (P = 0.03), homocysteine (P = 0.04) and triglycerides (P = 0.018) were significant predictors of CFR. CONCLUSIONS The present study suggests an important role for oxidized LDL and plasma homocysteine on early impairment of coronary reactivity in young adults.
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Affiliation(s)
- R Laaksonen
- Department of Medicine, University of Tampere, Finland
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164
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Reunanen A, Roivainen M, Kleemola M, Saikku P, Leinonen M, Hovi T, Knekt P, Leino A, Aromaa A. Enterovirus, mycoplasma and other infections as predictors for myocardial infarction. J Intern Med 2002; 252:421-9. [PMID: 12528760 DOI: 10.1046/j.1365-2796.2002.01052.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To study antibodies against five infectious agents for their prediction of major coronary events in men with and without evidence of coronary heart disease at baseline. DESIGN A case-control study nested within a prospective population study. SUBJECTS The study cases included 441 men 45-64 years old with nonfatal myocardial infarction or coronary death within a mean follow-up time of 10 years. A total of 165 men had already signs of heart disease at baseline, whilst 276 were apparently healthy at the beginning of the study. Two controls for each case were matched for age, heart disease status and place of residence. Antibodies against enterovirus, Mycoplasma pneumoniae, Chlamydia pneumoniae, cytomegalovirus and adenovirus were determined. RESULTS Men without reported baseline heart disease, but not those with heart disease, showing the highest quartile of antibodies to enterovirus and mycoplasma or increased levels of immune complex-bound antibodies to chlamydia had a significantly higher risk of coronary events than men with lower level of antibodies. The increased risk demonstrated in men with high levels of antibodies to enterovirus and mycoplasma remained significant after adjustment for other antibodies, acute-phase reactant and conventional risk factors. Serological evidence of infection by multiple agents was also significantly associated with coronary events. CONCLUSIONS Serological evidence for several infectious agents is associated with the risk of coronary heart disease, but only in men without baseline history of heart disease.
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Affiliation(s)
- A Reunanen
- Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland.
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165
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Maguire M, Coates ARM, Henderson B. Chaperonin 60 unfolds its secrets of cellular communication. Cell Stress Chaperones 2002; 7:317-29. [PMID: 12653476 PMCID: PMC514831 DOI: 10.1379/1466-1268(2002)007<0317:cuisoc>2.0.co;2] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2002] [Revised: 04/30/2002] [Accepted: 05/01/2002] [Indexed: 11/24/2022] Open
Abstract
The cell biology of the chaperonins (Cpns) has been intensively studied over the past 25 years. These ubiquitous and essential molecules assist proteins to fold into their native state and function to protect proteins from denaturation after stress. The structure of the most widely studied Cpn60, Escherichia coli GroEL, has been solved and its mechanism of protein folding action largely established. But in the last decade, evidence has accumulated to suggest that the Cpn60s have functions in addition to intracellular protein folding, particularly the ability to act as intercellular signals with a wide variety of biological effects. Cpn60 has the ability to stimulate cells to produce proinflammatory cytokines and other proteins involved in immunity and inflammation and may, therefore, provide a link between innate and adaptive immunity. Cpn60s are also thought to be pathogenic factors in a wide range of diseases and have recently been reported to be present in the circulation of normal subjects and those with heart disease. An interesting facet of these proteins is the finding that in spite of significant sequence conservation, individual Cpn60 proteins can express very different biological activities. This review discusses the work to date, which has revealed the cell-cell signaling actions of Cpn60 proteins.
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Affiliation(s)
- Maria Maguire
- Cellular Microbiology Research Group, Eastman Dental Institute, University College London, 256 Grays Inn Road, London WC1X 8LD, UK
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166
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Benzaquen LR, Yu H, Rifai N. High sensitivity C-reactive protein: an emerging role in cardiovascular risk assessment. Crit Rev Clin Lab Sci 2002; 39:459-97. [PMID: 12385503 DOI: 10.1080/10408360290795556] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Coronary heart disease (CHD) is the major cause of death in the developed world and screening for conventional cardiovascular risk factors fails to identify more than 50% of the individuals who will present with acute coronary syndromes. Chronic inflammation appears to play a significant role in the initiation and development of atherosclerosis. Recent investigations have shown an association between inflammatory markers such as C-reactive protein (CRP) and CHD. These markers have proven useful as prognostic indicators in acute coronary syndromes and in predicting future coronary events in apparently healthy men and women. The availability of high sensitivity CRP (hs-CRP) assays has been crucial in exploring the role of this acute phase reactant in primary prevention settings. In this review, we discuss the evidence associating these inflammatory markers, especially CRP, with the pathogenesis of atherosclerosis and acute coronary syndromes, and we address the mechanism of risk as well as the clinical utility of this marker.
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Affiliation(s)
- Laura R Benzaquen
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
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167
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Abstract
PURPOSE OF REVIEW Despite changes in lifestyle and the use of effective pharmacologic interventions to lower cholesterol levels, coronary heart disease remains the major cause of morbidity and mortality in the developed world. Cholesterol screening fails to identify almost 50% of those individuals who will present with acute coronary syndromes. Recent evidence from laboratory and prospective clinical studies demonstrates that atherosclerosis is not simply a disease of lipid deposition, but rather is an inflammatory process with highly specific cellular and molecular responses. The clinical utility of inflammatory markers has been examined in a variety of atherothrombotic diseases. Because C-reactive protein is highly stable in stored frozen samples, and automated and robust analytical systems for its measurement are available, it has become the most widely examined inflammatory marker. RECENT FINDINGS C-reactive protein has consistently been shown to be a useful prognostic indicator in acute coronary syndromes and is a strong predictor of future coronary events in apparently healthy individuals. In addition, C-reactive protein can identify individuals with normal lipid levels who are at increased risk for future coronary events. Because drugs such as aspirin and statins reduce inflammatory risk, C-reactive protein has the potential to guide the use of these therapies in high-risk individuals for primary prevention. SUMMARY C-reactive protein may have a role in global risk assessment for primary prevention and in targeting those patients who will benefit from anti-inflammatory therapies. In addition, it may also be a good prognostic indicator in patients with acute coronary syndromes.
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Affiliation(s)
- Nader Rifai
- Department of Laboratory Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.
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168
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Folsom AR, Aleksic N, Catellier D, Juneja HS, Wu KK. C-reactive protein and incident coronary heart disease in the Atherosclerosis Risk In Communities (ARIC) study. Am Heart J 2002; 144:233-8. [PMID: 12177639 DOI: 10.1067/mhj.2002.124054] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent evidence implicates inflammation in the pathogenesis of coronary heart disease (CHD). C-reactive protein, a plasma marker of inflammation, is a marker of CHD risk but has been studied in few prospective investigations of the general population. METHODS AND RESULTS We prospectively examined the association of CRP with incident CHD among middle-aged adults in the Atherosclerosis Risk In Communities (ARIC) study. With the use of a nested case-cohort approach, we measured CRP in stored, baseline blood samples of 2 groups of subjects in whom CHD developed during follow-up (242 incident cases from 1987 to 1993 and 373 from 1990 to 1995) and, for comparison, 2 stratified random samples of noncases. In analyses adjusted for demographic variables and traditional CHD risk factors, the relative risk of CHD across quintiles of CRP was 1.0, 0.8, 1.6, 1.9, and 1.5 for events from 1987 to 1995 (P for trend =.01). As expected, inclusion of fibrinogen, intracellular adhesion molecule-1, and white blood cell count (other potential markers of the inflammatory reaction) attenuated the association of CRP with CHD incidence. In a supplemental cross-sectional analysis, CRP was not associated with carotid intima-media thickness after adjustment for major risk factors. CONCLUSIONS C-reactive protein is a moderately strong marker of risk of CHD in this cohort of middle-aged adults, consistent with the role of inflammation in the pathogenesis of CHD events. The association was not specific to CRP because other markers of inflammation could largely account for the finding.
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Affiliation(s)
- Aaron R Folsom
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minn 55454-1015, USA.
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169
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Schmidt R, Schmidt H, Curb JD, Masaki K, White LR, Launer LJ. Early inflammation and dementia: a 25-year follow-up of the Honolulu-Asia Aging Study. Ann Neurol 2002; 52:168-74. [PMID: 12210786 DOI: 10.1002/ana.10265] [Citation(s) in RCA: 500] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Inflammatory responses are associated with cardiovascular disease and may be associated with dementing disease. We evaluated the long-term prospective association between dementia and high-sensitivity C-reactive protein, a nonspecific marker of inflammation. Data are from the cohort of Japanese American men who were seen in the second examination of the Honolulu Heart Program (1968-1970) and subsequently were reexamined 25 years later for dementia in the Honolulu-Asia Aging Study (1991-1996). In a random subsample of 1,050 Honolulu-Asia Aging Study cases and noncases, high-sensitivity C-reactive protein concentrations were measured from serum taken at the second examination; dementia was assessed in a clinical examination that included neuroimaging and neuropsychological testing and was evaluated using international criteria. Compared with men in the lowest quartile (<0.34mg/L) of high-sensitivity C-reactive protein, men in the upper three quartiles had a 3-fold significantly increased risk for all dementias combined, Alzheimer's disease, and vascular dementia. For vascular dementia, the risk increased with increasing quartile. These relations were independent of cardiovascular risk factors and disease. These data support the view that inflammatory markers may reflect not only peripheral disease, but also cerebral disease mechanisms related to dementia, and that these processes are measurable long before clinical symptoms appear.
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Affiliation(s)
- Reinhold Schmidt
- Department of Neurology, Karl-Franzens University, Graz, Austria
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170
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Ruel M, Laham RJ, Parker JA, Post MJ, Ware JA, Simons M, Sellke FW. Long-term effects of surgical angiogenic therapy with fibroblast growth factor 2 protein. J Thorac Cardiovasc Surg 2002; 124:28-34. [PMID: 12091805 DOI: 10.1067/mtc.2002.121974] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The long-term effects of surgical fibroblast growth factor 2 therapy are examined. METHODS In a randomized, double-blind study, fibroblast growth factor 2 (10 microg or 100 microg) or placebo (n = 8 each) was delivered in the ungraftable myocardial territory of patients concomitantly undergoing coronary artery bypass grafting. Patients were followed up to 32.2 +/- 6.8 months postoperatively with clinical assessment and nuclear perfusion imaging. RESULTS Baseline patient characteristics were similar between the 3 groups. There were 2 late deaths, one of pancreatic cancer and one of undetermined cause (both in the 100-microg fibroblast growth factor 2 group). Two patients (both in the control group) underwent a total of 6 repeat cardiac catheterizations for recurrent coronary events. Mean Canadian Cardiovascular Society angina class improved at late follow-up from baseline in all groups (P < or = .02); however, patients treated with either dose of fibroblast growth factor 2 had significantly more freedom from angina recurrence than those treated with placebo (P =.03). Late nuclear perfusion scans revealed a persistent reversible or a new, fixed perfusion defect in the ungraftable territory of 4 of 5 patients who received placebo versus only 1 of 9 patients treated with fibroblast growth factor 2 (P =.02). The overall sum of left ventricular stress perfusion defect scores was also lower in fibroblast growth factor 2-treated patients than in control subjects (1.3 +/- 1.4 vs 3.9 +/- 2.1, respectively; P =.04). A trend toward a higher late left ventricular ejection fraction was noted in fibroblast growth factor 2-treated patients (55.1% +/- 14.6% vs 44.3% +/- 6.5%, fibroblast growth factor 2-treated patients versus control subjects; P =.12). CONCLUSIONS These data suggest that surgical angiogenic therapy with sustained-release fibroblast growth factor 2 may result in a prolonged myocardial revascularization effect that could translate into clinical benefit.
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Affiliation(s)
- Marc Ruel
- Department of Surgery, Medicine, Angiogenesis Research Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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171
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Zebrack JS, Anderson JL. The role of inflammation and infection in the pathogenesis and evolution of coronary artery disease. Curr Cardiol Rep 2002; 4:278-88. [PMID: 12052267 DOI: 10.1007/s11886-002-0063-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Inflammation plays a major role in the initiation and progression of coronary artery disease (CAD) and the precipitation of acute coronary events. However, the inflammatory triggers are poorly understood. Noninfectious stimuli undoubtedly play a role. Recently, chronic infection has been proposed as another inflammatory trigger. Histologically, unstable atherosclerotic plaque contains activated macrophages and T lymphocytes, adhesion molecules, chemokines and cytokines, matrix-degrading enzymes, and prothrombotic factors. Circulating inflammatory markers such as C-reactive protein, fibrinogen, and interleukins are increased in high-risk cohorts and predict future risk. Experimental models and human studies have supported a role of infection in the promotion of atherosclerosis. Although the independent predictive value of seropositivity to individual agents has varied, total pathogen burden, the sum of seropositivities to many bacterial and viral vectors, has been more consistent. Whether antibiotics or vaccines will be useful in CAD prevention remains to be shown. Meanwhile, therapies with proven vascular anti-inflammatory effects (eg, diet, exercise, smoking cessation, aspirin, statins) should be optimized.
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Affiliation(s)
- James S Zebrack
- University of Utah School of Medicine, Department of Internal Medicine, Division of Cardiology, 30 North 1900 East, 4N100, Salt Lake City 84132-2401, USA
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172
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Bermudez EA, Ridker PM. C-reactive protein, statins, and the primary prevention of atherosclerotic cardiovascular disease. PREVENTIVE CARDIOLOGY 2002; 5:42-6. [PMID: 11872991 DOI: 10.1111/j.1520-037x.2002.1032.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Emerging data implicate inflammation as integral to atherosclerosis and its complications. From a clinical perspective, the inflammatory biomarker C-reactive protein has demonstrated consistent predictive value in the detection of individuals at high risk for cardiovascular disease. Therapy with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) reduces C-reactive protein as well as low-density lipoprotein cholesterol, thus providing a potential additional mechanism for the reduction in cardiovascular events associated with the use of these agents. Evidence from the Air Force/Texas Coronary Atherosclerosis Prevention Study suggests that statin therapy may be effective in reducing incident coronary events among those with elevated levels of C-reactive protein but normal levels of low-density lipoprotein cholesterol. These data, along with accumulating laboratory data, support a potential anti-inflammatory benefit of statins. Large-scale, randomized trials in the primary prevention of acute coronary events among individuals without overt hyperlipidemia but with evidence of elevated C-reactive protein are now needed to directly test this hypothesis.
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Affiliation(s)
- Edmund A Bermudez
- Center for Cardiovascular Disease Prevention, the Leducq Center for Cardiovascular Research, and the Divisions of Preventive Medicine and Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
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173
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Huhtinen M, Repo H, Laasila K, Jansson SE, Kautiainen H, Karma A, Leirisalo-Repo M. Systemic inflammation and innate immune response in patients with previous anterior uveitis. Br J Ophthalmol 2002; 86:412-7. [PMID: 11914210 PMCID: PMC1771091 DOI: 10.1136/bjo.86.4.412] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIM To determine the presence of systemic inflammation and innate immune responsiveness of patients with a history of acute anterior uveitis but no signs of ocular inflammation at the time of recruitment. METHODS Tumour necrosis factor alpha (TNF-alpha) production in response to bacterial lipopolysaccharide (LPS) was studied using whole blood culture assay; levels of TNF-alpha in culture supernatants, and soluble interleukin 2 receptor (sIL-2R) in serum were determined by chemiluminescent immunoassay (Immulite); monocyte surface expression of CD11b, CD14, and CD16 and the proportion of monocyte subsets CD14(bright)CD16(-) and CD14(dim)CD16(+) were studied with three colour whole blood flow cytometry; and serum C reactive protein (CRP) levels were determined using immunonephelometric high sensitivity CRP assay. RESULTS The CRP level (median, interquartile range) was significantly higher in 56 patients with previous uveitis than in 37 controls (1.59 (0.63 to 3.47) microg/ml v 0.81 (0.32 to 2.09) microg/ml; p=0.008). The TNF-alpha concentration of the culture media per 10(5) monocytes was significantly higher in the patient group than in the control group in the presence of LPS 10 ng/ml (1473 (1193 to 2024) pg/ml v 1320 (935 to 1555) pg/ml; p=0.012) and LPS 1000 ng/ml (3280 (2709 to 4418) pg/ml v 2910 (2313 to 3358) pg/ml; p=0.011). The background TNF-alpha release into the culture media was low in both groups. CD14 expression of CD14(bright)CD16(-) monocytes, defined as antibody binding capacity (ABC), was similar for the patients and controls (22,839 (21,038 to 26,020) ABC v 21,657 (19,854 to 25,646) ABC). CONCLUSIONS Patients with previous acute anterior uveitis show high innate immune responsiveness that may play a part in the development of ocular inflammation.
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Affiliation(s)
- M Huhtinen
- Department of Ophthalmology, University of Helsinki, Helsinki, Finland.
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174
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Johnston SD, Morris JK, Cramb R, Gunson BK, Neuberger J. Cardiovascular morbidity and mortality after orthotopic liver transplantation. Transplantation 2002; 73:901-6. [PMID: 11923689 DOI: 10.1097/00007890-200203270-00012] [Citation(s) in RCA: 268] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hyperlipidemia and hypertension have been reported in liver allograft recipients and contribute to an increased risk of ischemic heart disease (IHD) after orthotopic liver transplantation (OLT). The aims of the study were (1) to determine the prevalence of risk factors for IHD in these patients and (2) to compare the observed incidence of cardiovascular events and related mortality in allograft recipients with a matched population. METHODS One hundred ten consecutive adults (50 male) who attended for review after OLT (median follow-up 3.9 years; range 0.1-17.9) were assessed for cardiovascular risk factors using current blood pressure, diabetic status, and smoking history and measurements of total cholesterol, high-density lipoprotein cholesterol, and triglyceride concentrations. Cardiovascular events and cardiovascular mortality data were collected from the prospective database of all adult liver allograft recipients and compared to matched data from myocardial infarction registries and Office for National Statistics data, respectively. RESULTS Raised serum cholesterol (>5.0 mmol/L) was found in 48 (44%) patients (18 male), and systolic hypertension (>140 mmHg) was found in 69 (63%) patients (27 male). The relative risk of ischemic cardiac events was 3.07 (95% [confidence interval] CI, 1.98-4.53) and the relative risk for cardiovascular deaths was 2.56 (95% CI, 1.52-4.05) in allograft recipients compared to an age-matched population without transplants. CONCLUSIONS Liver allograft recipients have a greater risk of cardiovascular deaths and ischemic events than an age- and sex-matched population. The prevalence of raised cholesterol concentrations in patients after OLT is similar to those in previous reports. Moderate hypertension and hyperlipidemia may be more detrimental in patients after OLT compared to non-transplant patients without these risk factors.
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175
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de Ferranti S, Rifai N. C-reactive protein and cardiovascular disease: a review of risk prediction and interventions. Clin Chim Acta 2002; 317:1-15. [PMID: 11814453 DOI: 10.1016/s0009-8981(01)00797-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Coronary vascular disease (CVD) has a high prevalence in the United States, yet 40-50% of those with that diagnosis have normal or mildly increased cholesterol levels. Increased C-reactive protein (CRP) has been associated with CVD, in those presenting after an acute coronary event, and also in apparently healthy individuals. METHODS We reviewed the literature on this association, and on the relationship between CRP and traditional CVD risk factors including smoking, hypertension, cholesterol and obesity. Also examined is the effect of various medications used in patients with CVD on CRP concentrations. RESULTS CRP correlates with risk of CVD in patients who have a history of acute coronary disease, stable angina, and in those who have never been diagnosed with CVD. CRP imparts risk that is independent of hyperlipidemia. CONCLUSION Once commercially available CRP assays are shown to be reliable, CRP may help predict short- and long-term cardiovascular outcomes and may have a role in CVD screening analogous to that of lipid. In the future CRP may modify treatment and preventive therapies.
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Affiliation(s)
- Sarah de Ferranti
- Department of Cardiology, Children's Hospital and Harvard Medical School, Boston, MA, USA
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176
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Stöllberger C, Finsterer J. Role of infectious and immune factors in coronary and cerebrovascular arteriosclerosis. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2002; 9:207-15. [PMID: 11874854 PMCID: PMC119967 DOI: 10.1128/cdli.9.2.207-215.2002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Claudia Stöllberger
- Second Medical Department, Krankenanstalt Rudolfstiftung, A-1130 Vienna, Austria.
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177
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Tarkkinen P, Palenius T, Lövgren T. Ultrarapid, Ultrasensitive One-Step Kinetic Immunoassay for C-Reactive Protein (CRP) in Whole Blood Samples: Measurement of the Entire CRP Concentration Range with a Single Sample Dilution. Clin Chem 2002. [DOI: 10.1093/clinchem/48.2.269] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background: Recently, measurement of very low concentrations of C-reactive protein (CRP) has gained popularity as a potential new means for predicting the risk of future cardiac complications. In this study, we demonstrate the feasibility of a kinetic, one-step microparticle assay for quantitative determination of extremely low and high CRP concentrations in the limited timeframe typical for point-of-care testing.
Methods: A noncompetitive, kinetic CRP immunoassay was developed that uses individual, porous microparticles as the solid phase. The microparticles were covalently coated with a monoclonal capture antibody, and the monoclonal detection antibody was labeled with europium. The one-step binding reaction was stopped by washing after 2 min of incubation, and the fluorescence signal of individual particles was measured.
Results: The analytical detection limit (mean of zero calibrator + 3 SD) was 0.00016 mg/L CRP. Clinical samples were diluted 400-fold before assay to cover the CRP concentration range of 0.064–1200 mg/L. The assay correlated well with the Dade Behring N High Sensitivity CRP assay (for 0–10 mg/L, r = 0.969, Sy|x = 0.68, n = 54; for 0–350 mg/L, r = 0.969, Sy|x = 11.7, n = 100). The within- and between-run CVs based on calculated concentrations were, respectively, 9–16% and 14% at 0.11 mg/L, 4.5–12% and 8.2% at 4.2 mg/L, and 3.5–6.3% and 4.4% at 105 mg/L, with a CV <15% at 0.2 mg/L and above.
Conclusions: Use of the kinetic microparticle approach combined with time-resolved fluorometry allows ultrasensitive quantification of CRP in whole blood in 2 min with a linear assay range spanning more than four orders of magnitude.
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Affiliation(s)
- Piia Tarkkinen
- Department of Biotechnology, University of Turku, Tykistökatu 6A, 6th Floor, FIN-20520 Turku, Finland
| | - Tom Palenius
- PerkinElmer Life Sciences/Wallac Oy, PO Box 10, FIN-20101 Turku, Finland
| | - Timo Lövgren
- Department of Biotechnology, University of Turku, Tykistökatu 6A, 6th Floor, FIN-20520 Turku, Finland
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178
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McKechnie RS, Rubenfire M. The role of inflammation and infection in coronary artery disease: a clinical perspective. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1062-1458(01)00531-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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179
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Leinonen M, Saikku P. Evidence for infectious agents in cardiovascular disease and atherosclerosis. THE LANCET. INFECTIOUS DISEASES 2002; 2:11-7. [PMID: 11892489 DOI: 10.1016/s1473-3099(01)00168-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
During the past decade, several novel risk factors for atherosclerosis, including inflammation and infections, have been reported. Seroepidemiological studies suggest an association between several microbes and coronary heart disease. Microbes or their structural components are found in atherosclerotic plaques, but the only intact microbes commonly present are herpes viruses and Chlamydia pneumoniae. These agents are able to initiate and accelerate atherosclerosis in animal models. If they cause persistent infection in the vessel wall, they can directly promote a proinflammatory, procoagulant, and proatherogenic environment. Microbes could also have a remote effect--e.g., bacterial heat shock proteins with high sequence homology with human counterpart could, in the presence of a chronic infection, induce autoimmunity against vascular cells, and lead to an atherosclerotic process. Several intervention trials with antibiotics are underway, and will hopefully shed new light on the role of bacteria in atherosclerosis. The causal relationship can be proved by use of vaccination to prevent infections.
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Affiliation(s)
- Maija Leinonen
- National Public Health Institute, PO Box 310, FIN-90101 Oulu, Finland.
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180
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Hamwi A, Vukovich T, Wagner O, Rumpold H, Spies R, Stich M, Langecker C. Evaluation of Turbidimetric High-Sensitivity C-Reactive Protein Assays for Cardiovascular Risk Estimation. Clin Chem 2001. [DOI: 10.1093/clinchem/47.11.2044] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ahmad Hamwi
- Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Vienna, AKH Leitstelle 5H, Waehringerguertel 18, A-1090 Vienna, Austria
| | - Thomas Vukovich
- Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Vienna, AKH Leitstelle 5H, Waehringerguertel 18, A-1090 Vienna, Austria
| | - Oswald Wagner
- Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Vienna, AKH Leitstelle 5H, Waehringerguertel 18, A-1090 Vienna, Austria
| | - Helmut Rumpold
- Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Vienna, AKH Leitstelle 5H, Waehringerguertel 18, A-1090 Vienna, Austria
| | - Roswitha Spies
- Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Vienna, AKH Leitstelle 5H, Waehringerguertel 18, A-1090 Vienna, Austria
| | - Martina Stich
- Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Vienna, AKH Leitstelle 5H, Waehringerguertel 18, A-1090 Vienna, Austria
| | - Carina Langecker
- Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Vienna, AKH Leitstelle 5H, Waehringerguertel 18, A-1090 Vienna, Austria
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181
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Whicher J, Rifai N, Biasucci LM. Markers of the acute phase response in cardiovascular disease: an update. Clin Chem Lab Med 2001; 39:1054-64. [PMID: 11831621 DOI: 10.1515/cclm.2001.171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There is now widespread agreement that inflammation is a key component in the progression of atheromatous lesions. Inflammatory cells are present at all stages in the development of the atheromatous plaque, and gene knockout experiments in mice show that atheroma is largely prevented in the absence of the normal inflammatory mediators. In humans reduction of inflammation accompanies successful treatment strategies for atheroma. An increasing number of studies suggest that the acute phase protein, C-reactive protein, provides increased prognostic information over and above existing markers of atheroma severity or progression in healthy individuals and in the acute coronary syndromes. Recent advances in our knowledge of the normal variability of C-reactive protein levels and in precise and sensitive measurements strengthen the arguments for adding this marker to the repertoire of the routine laboratory assessment of cardiovascular disease.
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182
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Mosorin M, Juvonen J, Biancari F, Satta J, Surcel HM, Leinonen M, Saikku P, Juvonen T. Use of doxycycline to decrease the growth rate of abdominal aortic aneurysms: a randomized, double-blind, placebo-controlled pilot study. J Vasc Surg 2001; 34:606-10. [PMID: 11668312 DOI: 10.1067/mva.2001.117891] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Eradication of Chlamydia pneumoniae infection and inhibition of elastolytic matrix metalloproteinases with doxycycline have been suggested to reduce the growth rates of small abdominal aortic aneurysms (AAA). We designed a study to investigate the efficacy of doxycycline in reducing the expansion of small AAAs. SUBJECTS AND METHODS This was a prospective, double-blind, randomized, placebo-controlled study that was set in a university referral hospital. The study group consisted of 32 of 34 initially eligible patients who had an AAA diameter perpendicular to the aortic axis of 30 mm or more in size or a ratio of infrarenal to suprarenal aortic diameter of 1.2 or more and a diameter less than 55 mm. Patients were randomly assigned to receive either doxycycline (150 mg daily) or placebo during a 3-month period and underwent ultrasound surveillance during an 18-month period. Outcome measures included aneurysm expansion rates, the number of patients who had AAA rupture or repair, C pneumoniae antibody titers, and serum concentrations of C-reactive protein. RESULTS The aneurysm expansion rate in the doxycycline group was significantly lower than that in the placebo group during the 6- to 12-month (P = .01) and the 12- to 18-month periods (P =.01). Five patients (41%) in the placebo group and 1 patient (7%) in the doxycycline group had an overall expansion of the aneurysm of 5 mm or more during the 18-month follow-up. Among the placebo group patients, a higher expansion rate was observed in those with enhanced C pneumoniae immunoglobulin G antibody titers (> 128) than in those with lower titers (P = .03). Doxycycline treatment had no clear effect on antibody titers. However, at 6-month follow-up, C-reactive protein levels in the doxycycline group were significantly lower than the baseline levels (P = .01). CONCLUSIONS The results of this small pilot study suggest that doxycycline may favorably alter the outcome of patients with small AAA. However, because of the small size of this randomized study and of the potentially confounding effect of pretreatment risk factors, doxycycline-based treatment cannot be justified only on the ground of the current results. Because of the high prevalence of this disorder and its clinical, social, and economic relevance, a multicenter study should be performed to further investigate whether there is any place for medical treatment of small AAAs.
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Affiliation(s)
- M Mosorin
- Department of Surgery, University of Oulu, Finland
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183
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Gattone M, Iacoviello L, Colombo M, Castelnuovo AD, Soffiantino F, Gramoni A, Picco D, Benedetta M, Giannuzzi P. Chlamydia pneumoniae and cytomegalovirus seropositivity, inflammatory markers, and the risk of myocardial infarction at a young age. Am Heart J 2001; 142:633-40. [PMID: 11579353 DOI: 10.1067/mhj.2001.118118] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pathogens causing chronic infections may promote atherosclerosis. The aim of our study was to evaluate the association of Chlamydia pneumoniae (Cp) and cytomegalovirus (CMV) infection and of inflammatory activation with premature myocardial infarction (MI). METHODS Specific anti-Cp and anti-CMV immunoglobulin G (IgG), fibrinogen, white blood cells (WBC), and C-reactive protein (CRP) were measured in 120 post-MI patients </=50 years old and in 120 age-matched controls. RESULTS Seropositivity to Cp and elevated concentrations of anti-Cp and anti-CMV IgGs were more frequent (P =.01) in patients than in control subjects, and fibrinogen, CRP, and WBC levels (P =.02) were more elevated. After adjustment for coronary risk factors and socioeconomic status, the odds ratios (95% confidence intervals) for premature MI were 2.4 (1.3-4.6) for Cp infection and 2.9 (1.5-5.8) for CMV. The risk of Cp infection was greater in smokers (3.7, 1.8-7.6). When both infections were present (35% of patients vs 8% of controls, P =.001), CRP was higher (P =.01) and the risk increased by 12 times (12.5, 4-38.9) compared with that in subjects without any infection and by 5 times (4.9, 2.2-10.9) if only one was present. CONCLUSIONS After adjustment for confounders, seropositivity to both Cp and CMV infections is associated with the diagnosis of premature MI. The combination of both infections is associated with an enhanced inflammatory response and a markedly increased risk of premature MI.
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Affiliation(s)
- M Gattone
- Cardiology Department and Laboratory Unit, "Salvatore Maugeri" Foundation, Istituto di Ricerca e Cura a Carettere Scientifico, Institute for Clinical Careand Research,Medical Center of Rehabilitation, Veruno, Italy.
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184
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Song H, Tasaki H, Yashiro A, Yamashita K, Taniguchi H, Nakashima Y. Acute-phase proteins and Chlamydia pneumoniae infection: which one is more important in acute coronary syndrome? JAPANESE CIRCULATION JOURNAL 2001; 65:853-7. [PMID: 11665787 DOI: 10.1253/jcj.65.853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Elevated levels of acute-phase proteins, a systemic marker for inflammation, predict coronary events; Chlamydia pneumoniae (C. pneumoniae) infection is associated with coronary atherosclerosis. The present study investigated whether inflammation or infection is involved in the pathogenesis of acute coronary syndrome (ACS) and which one has the more important role. The study group comprised 49 patients with angiographically diagnosed ACS, 48 cases of chronic coronary heart disease (CCHD), and 44 subjects with a normal coronary profile. The levels of serum C-reactive protein (CRP), fibrinogen and anti-C. pneumoniae IgG antibody were measured. The IgG antibody against C. pneumoniae was higher in the ACS and CCHD groups compared with the control group after adjusting for age and gender. The levels of CRP and fibrinogen were significantly increased in patients with ACS compared with controls and CCHD patients. Multiple stepwise logistic regression analysis revealed that C. pneumoniae IgG antibody is an independent risk factor for both ACS and CCHD (odds ratio 2.3 and 2.1, respectively), but the CRP level is a risk factor only for ACS (odds ratio 6.9). The inflammatory response, as indicated by acute-phase proteins, especially CRP, rather than C. pneumoniae infection, may contribute more to the clinical course of ACS.
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Affiliation(s)
- H Song
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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185
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Chandra HR, Choudhary N, O'Neill C, Boura J, Timmis GC, O'Neill WW. Chlamydia pneumoniae exposure and inflammatory markers in acute coronary syndrome (CIMACS). Am J Cardiol 2001; 88:214-8. [PMID: 11472696 DOI: 10.1016/s0002-9149(01)01628-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Previous studies have shown higher levels of Chlamydia pneumoniae (C. pneumoniae, CP) antibody titers (CPIgG), C-reactive protein (CRP), and fibrinogen in patients with coronary artery disease. The role of these infectious and inflammatory markers in precipitating acute coronary syndrome (ACS) is unclear. We conducted a cross-sectional study on patients (n = 830, mean age 63 +/- 15 years, 57% male) admitted to the chest pain center of our institution. The differences in the CPIgG, CRP, and fibrinogen levels in patients who were diagnosed with ACS versus those who were not (non-ACS) were evaluated. CPIgG titers tended to be higher in the ACS group than in the non-ACS group. However, when different titers were used to define seropositivity, the difference achieved statistical significance only at the titer of > or =1:1,024 (35% vs 26%, p = 0.004). CRP (median 0.48 vs 0.33 mg/dl, p <0.0001), fibrinogen (median 317 vs 293 mg/dl, p <0.0001), and leukocyte count (median 7.7 vs 6.9 10(9)/L, p <0.0001) were higher in the ACS group. On multivariate analysis, CPIgG > or =1:1,024 (odds ratio [OR] 1.62), diabetes (OR 1.91), hypertension (OR 1.46), prior myocardial infarction (OR 1.78), smoking (OR 1.70), Caucasian race (OR 1.7), high-density lipoprotein (OR 0.98), and elevated troponin-T (OR 12.44) were the only factors independently associated with ACS. Thus, we found a strong association between high level seropositivity to CP and ACS. This may indicate recent re-infection or an exaggerated immune response to CP as an etiologic factor for ACS. This study also suggests that therapeutic interventions may need to be specifically targeted to these patients.
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Affiliation(s)
- H R Chandra
- Division of Cardiology, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA
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186
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Kervinen H, Palosuo T, Manninen V, Tenkanen L, Vaarala O, Mänttäri M. Joint effects of C-reactive protein and other risk factors on acute coronary events. Am Heart J 2001; 141:580-5. [PMID: 11275923 DOI: 10.1067/mhj.2001.113572] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Elevated serum C-reactive protein (CRP) is a predictor of coronary heart disease in population samples. We studied the contribution of the simultaneous presence (joint effects) of elevated CRP and the classic as well as some new risk factors on acute coronary events. METHODS With a nested case-control design and logistic regression analyses, we measured baseline and pre-event CRP levels in patients who had myocardial infarction or coronary death (cases) during an 8.5-year follow-up in the Helsinki Heart Study, a coronary primary prevention trial in dyslipidemic middle-aged men. The control patients were participants remaining free of coronary events. RESULTS Baseline and pre-event CRP levels were higher in cases than in control patients (4.4 vs 2.0 mg/L, P <.001 and 6.0 vs 3.6 mg/L, P <.001). The relative risk attributed to elevated CRP was 40% higher with chronic elevation (odds ratio [OR], 3.34) compared with high baseline (OR, 2.24) or pre-event (OR, 2.26) level only. Hypertension, low high-density lipoprotein cholesterol, and high leukocyte count increased the risk only marginally without simultaneous occurrence of high CRP, whereas the joint effects of CRP and these classic risk factors suggested additive effects on coronary risk. In contrast, high levels of immunoglobulin G-class antibodies to oxidized low-density lipoprotein and antiprothrombin antibodies as well as high total immunoglobulin G level increased the risk irrespective of CRP. CONCLUSIONS Elevated CRP enhances the risks attributed to classic coronary risk factors.
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Affiliation(s)
- H Kervinen
- Department of Medicine, Hyvinkää Hospital, Sairaalakatu 1, 05850 Hyvinkää, Finland.
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187
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Roberts WL, Moulton L, Law TC, Farrow G, Cooper-Anderson M, Savory J, Rifai N. Evaluation of Nine Automated High-Sensitivity C-Reactive Protein Methods: Implications for Clinical and Epidemiological Applications. Part 2. Clin Chem 2001. [DOI: 10.1093/clinchem/47.3.418] [Citation(s) in RCA: 349] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background: C-Reactive protein (CRP) can provide prognostic information about risk of future coronary events in apparently healthy subjects. This application requires higher sensitivity assays than have traditionally been available in the clinical laboratory.
Methods: Nine high-sensitivity CRP (hs-CRP) methods from Dade Behring, Daiichi, Denka Seiken, Diagnostic Products Corporation, Iatron, Kamiya, Olympus, Roche, and Wako were evaluated for limit of detection, linearity, precision, prozone effect, and comparability with samples from 388 apparently healthy individuals.
Results: All methods had limits of detection that were lower than the manufacturers’ claimed limit of quantification except for the Kamiya, Roche, and Wako methods. All methods were linear at 0.3–10 mg/L. The Diagnostic Products Corporation, Kamiya, Olympus, and Wako methods had imprecision (CVs) >10% at 0.15 mg/L. The Iatron, Olympus, and Wako methods demonstrated prozone effects at hs-CRP concentrations of 12, 206, and 117 mg/L, respectively. hs-CRP concentrations demarcating each quartile in a healthy population were method-dependent. Ninety-two to 95% of subjects were classified into the same quartile of hs-CRP established by the Dade Behring method by the Denka Seiken, Diagnostic Products Corporation, Iatron, and Wako methods. In contrast, 68–77% of subjects were classified into the same quartile by the Daiichi, Kamiya, Olympus, and Roche methods. No subject varied by more than one quartile by any method.
Conclusions: Four of the nine examined hs-CRP methods classified apparently healthy subjects into quartiles of hs-CRP similar to the classifications assigned by the comparison method. Additional standardization efforts are required because an individual patient’s results will be interpreted using population-based cutpoints.
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Affiliation(s)
- William L Roberts
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT 84132
| | - Linda Moulton
- ARUP Institute for Experimental and Clinical Pathology, Salt Lake City, UT 84108
| | - Terence C Law
- Departments of Laboratory Medicine and Pathology, Children’s Hospital and Harvard Medical School, Boston, MA 02115
| | - Genesis Farrow
- Departments of Laboratory Medicine and Pathology, Children’s Hospital and Harvard Medical School, Boston, MA 02115
| | | | - John Savory
- Departments of Pathology and
- Biochemistry and Molecular Genetics, University of Virginia Health Science Center, Charlottesville, VA 22908
| | - Nader Rifai
- Departments of Laboratory Medicine and Pathology, Children’s Hospital and Harvard Medical School, Boston, MA 02115
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188
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Abstract
BACKGROUND There is growing interest in the role of microbes in the pathogenesis of coronary atherosclerosis but most of the evidence has been seroepidemiologic. It would be useful to know more about the cytology and histology of coronary lesions containing clearly depicted microbes. OBJECTIVE To define carefully the assorted abnormalities apparent in the coronary arteries of individuals dying with Whipple's disease. METHODS Myocardial tissue from 12 cases of Whipple's disease was studied by light microscopy. Slides were stained routinely (in sequence) with either the periodic-acid-Schiff (PAS) or Goldner-trichrome method and some with Gomori methenimine silver. Cardiac slides with PAS-positive bacilli were compared to lesions in jejunal lamina propria. RESULTS There were abundant sites of coronary arterial damage associated with presence of Whipple bacilli, more in the tunica media than in intima and adventitia. Bacilli in the arterial lesions were identical to those in lamina propria. Medial lesions were often associated with a fibroproliferative 'atheroma'. Both intracellular and extracellular bacilli were found. Most lesions were devoid of inflammation, but some sites exhibited either florid arteritis or dense scarring. Arteries that were scarred or inflamed exhibited only a few bacilli. There was an apparent affinity of bacilli for the nuclei in medial smooth muscle cells and in nearby ventricular myocytes. Apoptosis (TUNEL-positive) was present in medial smooth muscle cells, endothelial cells, and ventricular myocytes. CONCLUSIONS There is a wide spectrum of coronary abnormalities in Whipple's disease. It would be useful to know how often the Whipple bacillus is a part of the total pathogen burden in coronary disease.
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Affiliation(s)
- T N James
- Department of Medicine, University of Texas Medical Branch in Galveston, 77555-0175, USA
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189
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Rifai N, Ridker PM. High-Sensitivity C-Reactive Protein: A Novel and Promising Marker of Coronary Heart Disease. Clin Chem 2001. [DOI: 10.1093/clinchem/47.3.403] [Citation(s) in RCA: 350] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background: Coronary heart disease remains the leading cause of morbidity and mortality in the industrialized world. Clinical and laboratory studies have shown that inflammation plays a major role in the initiation, progression, and destabilization of atheromas. C-Reactive protein (CRP), an acute phase reactant that reflects low-grade systemic inflammation, has been studied in a variety of cardiovascular diseases.
Approach: Findings from prospective clinical trials were examined to determine the prognostic utility of CRP in acute coronary syndromes, and observations from epidemiological studies were reviewed to determine the ability of CRP to predict future first coronary events. The analytical considerations of CRP measurement in these clinical applications were also examined.
Content: In patients with established coronary disease, CRP has been shown to predict adverse clinical events. In addition, prospective studies have consistently shown that CRP is a strong predictor of future coronary events in apparently healthy men and women. The relative risk associated with CRP is independent of other cardiovascular disease risk factors. High-sensitivity CRP (hs-CRP) assays are needed for risk assessment of cardiovascular disease. Such assays are currently available but may require further standardization because patients’ results will be interpreted using population-based cutpoints. Preventive therapies to attenuate coronary risk in individuals with increased hs-CRP concentrations include aspirin and statin-type drugs.
Summary: hs-CRP has prognostic utility in patients with acute coronary syndromes and is a strong independent predictor of future coronary events in apparently healthy subjects.
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Affiliation(s)
- Nader Rifai
- Department of Laboratory Medicine, Children’s Hospital
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine, and
- Pathology and
| | - Paul M Ridker
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine, and
- Cardiovascular Diseases, Brigham and Women’s Hospital, and Departments of
- Medicine, Harvard Medical School, Boston, MA 02115
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190
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Shimada K, Daida H, Mokuno H, Watanabe Y, Sawano M, Iwama Y, Seki E, Kurata T, Sato H, Ohashi S, Suzuki H, Miyauchi K, Takaya J, Sakurai H, Yamaguchi H. Association of seropositivity for antibody to Chlamydia-specific lipopolysaccharide and coronary artery disease in Japanese men. JAPANESE CIRCULATION JOURNAL 2001; 65:182-7. [PMID: 11266192 DOI: 10.1253/jcj.65.182] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Recent studies suggest an association between Chlamydia pneumoniae infection and coronary artery disease (CAD). To examine this relationship in Japanese men, serum IgA and IgG antibodies to Chlamydia-specific lipopolysaccharide were measured by enzyme-linked immunosorbent assay in 507 patients with CAD and 200 age-matched controls. CAD patients were divided into (1) 269 patients with myocardial infarction (MI) and (2) 238 patients with chronic coronary heart disease (CCHD). Compared with the control group, the CAD group did not differ in the prevalences of both antibodies (IgA: 23.7 vs 18.0%, p=0.10; IgG: 52.7 vs 51.0%, p=0.6). The index of IgG antibody was not significantly different between CAD and control groups (median 1.19 vs 1.18, p=0.3), whereas the index of IgA antibody was significantly higher in CAD than control group (median 0.60 vs 0.46, p<0.0001). Compared with the control group, the MI group had a significantly higher prevalence of IgA antibody (28.6 vs 18.0%, p=0.007); however, there was no difference in the prevalence of IgG antibody (58.0 vs 51.0%, p=0.13). The CCHD group did not differ in the prevalences of both antibodies (IgA: 18.1 vs 18.0%, p=0.9; IgG: 45.6 vs 51.0%, p=0.2). After the adjustment for coronary risk factors, odds ratios (ORs) of seropositive antibodies for CAD were 1.59 [95% confidence interval (CI): 0.88-2.87, p=0.12] for IgA seropositivity and 0.92 (95%CI: 0.58-1.47, p=0.7) for IgG seropositivity in all cases. In the MI and control groups, ORs of seropositive antibodies for MI were 2.67 (95%CI: 1.32-5.38, p=0.007) for IgA seropositivity, and 1.36 (95%CI: 0.79-2.36, p=0.2) for IgG seropositivity. This study discovered that IgA antibody to Chlamydia was significantly associated with CAD, especially with MI, in Japanese Men and the findings suggest that chronic infection of Chlamydia may be linked to the pathogenesis of MI.
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Affiliation(s)
- K Shimada
- Department of Cardiology, Juntendo University, School of Medicine, Tokyo, Japan.
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191
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Rifai N, Ridker PM. Proposed Cardiovascular Risk Assessment Algorithm Using High-Sensitivity C-Reactive Protein and Lipid Screening. Clin Chem 2001. [DOI: 10.1093/clinchem/47.1.28] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nader Rifai
- Department of Laboratory Medicine, Children’s Hospital
- Center for Cardiovascular Disease Prevention, The Leducq Center for Molecular and Genetic Epidemiology of Cardiovascular Disorders
- Department of Pathology and
| | - Paul M Ridker
- Center for Cardiovascular Disease Prevention, The Leducq Center for Molecular and Genetic Epidemiology of Cardiovascular Disorders
- Divisions of Cardiovascular Disease and Preventive Medicine, Brigham and Women’s Hospital, and, Departments of
- Department of Medicine, Harvard Medical School, Boston, MA 02115
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192
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Abstract
A body of evidence supports an association between Chlamydia pneumoniae and atherosclerosis. Recent prospective, seroepidemiologic studies have refined estimations of relative risk. Advances in diagnostic testing with the polymerase chain reaction have created a potential opportunity to screen for infected individuals. New insights into the pathogenesis of infection with C. pneumoniae have been reported, many of which are relevant to the development of atherosclerotic plaque. Clinical trials have now been initiated and should provide guidance as to the utility of antibiotics in the treatment or prevention of coronary artery disease.
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Affiliation(s)
- Michael Dunne
- Pfizer Global Research Division, Groton, Connecticut, USA
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193
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Tsang TS, Barnes ME, Gersh BJ, Hayes SN. Risks of coronary heart disease in women: current understanding and evolving concepts. Mayo Clin Proc 2000; 75:1289-303. [PMID: 11126839 DOI: 10.4065/75.12.1289] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The population of older individuals in the United States is growing rapidly. Because women generally live longer than men and make up the majority of this aging population, the elucidation of health issues related to older women is important. Cardiovascular disease is the leading cause of death and disability for women and claims the lives of more women than the next 14 causes combined. The majority of these deaths are due to atherosclerotic coronary heart disease, with nearly 250,000 women dying of myocardial infarction each year. There is evidence that women with suspected or established cardiovascular disease have not benefited fully from recent advances in the detection and management of coronary heart disease. Regardless of the mechanism and extent of the effect that sex differences have on approaches to cardiovascular disease, women appear to benefit from proven efficacious therapies, and the longer-term outcomes associated with these treatments are positive. The data regarding women and coronary heart disease are rapidly evolving and sometimes conflicting. The intent of this article is to summarize the most current understanding of coronary heart disease risks in women, highlighting the impact of prevention, and to discuss the latest novel findings that may become important in our armamentarium for prevention of coronary heart disease.
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Affiliation(s)
- T S Tsang
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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194
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Danesh J, Whincup P, Walker M, Lennon L, Thomson A, Appleby P, Gallimore JR, Pepys MB. Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. BMJ (CLINICAL RESEARCH ED.) 2000; 321:199-204. [PMID: 10903648 PMCID: PMC27435 DOI: 10.1136/bmj.321.7255.199] [Citation(s) in RCA: 1120] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess associations between baseline values of four different circulating markers of inflammation and future risk of coronary heart disease, potential triggers of systemic inflammation (such as persistent infection), and other markers of inflammation. DESIGN Nested case-control comparisons in a prospective, population based cohort. SETTING General practices in 18 towns in Britain. PARTICIPANTS 506 men who died from coronary heart disease or had a non-fatal myocardial infarction and 1025 men who remained free of such disease until 1996 selected from 5661 men aged 40-59 years who provided blood samples in 1978-1980. MAIN OUTCOME MEASURES Plasma concentrations of C reactive protein, serum amyloid A protein, and serum albumin and leucocyte count. Information on fatal and non-fatal coronary heart disease was obtained from medical records and death certificates. RESULTS Compared with men in the bottom third of baseline measurements of C reactive protein, men in the top third had an odds ratio for coronary heart disease of 2.13 (95% confidence interval 1.38 to 3.28) after age, town, smoking, vascular risk factors, and indicators of socioeconomic status were adjusted for. Similar adjusted odds ratios were 1.65 (1.07 to 2.55) for serum amyloid A protein; 1.12 (0.71 to 1.77) for leucocyte count; and 0.67 (0.43 to 1.04) for albumin. No strong associations were observed of these factors with Helicobacter pylori seropositivity, Chlamydia pneumoniae IgG titres, or plasma total homocysteine concentrations. Baseline values of the acute phase reactants were significantly associated with one another (P<0.0001), although the association between low serum albumin concentration and leucocyte count was weaker (P=0.08). CONCLUSION In the context of results from other relevant studies these findings suggest that some inflammatory processes, unrelated to the chronic infections studied here, are likely to be involved in coronary heart disease.
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Affiliation(s)
- J Danesh
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE
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195
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Danesh J, Whincup P, Walker M, Lennon L, Thomson A, Appleby P, Wong Y, Bernardes-Silva M, Ward M. Chlamydia pneumoniae IgG titres and coronary heart disease: prospective study and meta-analysis. BMJ (CLINICAL RESEARCH ED.) 2000; 321:208-13. [PMID: 10903653 PMCID: PMC27437 DOI: 10.1136/bmj.321.7255.208] [Citation(s) in RCA: 204] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2000] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the association between coronary heart disease and serum markers of chronic Chlamydia pneumoniae infection. DESIGN "Nested" case-control analysis in a prospective cohort study and an updated meta-analysis of previous relevant studies. SETTING General practices in 18 towns in Britain. PARTICIPANTS Of the 5661 men aged 40-59 who provided blood samples during 1978-80, 496 men who died from coronary heart disease or had non-fatal myocardial infarction and 989 men who had not developed coronary heart disease by 1996 were included. MAIN OUTCOME MEASURES IgG serum antibodies to C pneumoniae in baseline samples; details of fatal and non-fatal coronary heart disease from medical records and death certificates. RESULTS 200 (40%) of the 496 men with coronary heart disease were in the top third of C pneumoniae titres compared with 329 (33%) of the 989 controls. The corresponding odds ratio for coronary heart disease was 1.66 (95% confidence interval 1.25 to 2.21), which fell to 1.22 (0.82 to 1.82) after adjustment for smoking and indicators of socioeconomic status. No strong associations were observed between C pneumoniae IgG titres and blood lipid concentrations, blood pressure, or plasma homocysteine concentration. In aggregate, the present study and 14 other prospective studies of C pneumoniae IgG titres included 3169 cases, yielding a combined odds ratio of 1. 15 (0.97 to 1.36), with no significant heterogeneity among the separate studies (chi(2)=10.5, df=14; P>0.1). CONCLUSION This study, together with a meta-analysis of previous prospective studies, reliably excludes the existence of any strong association between C pneumoniae IgG titres and incident coronary heart disease. Further studies are required, however, to confirm or refute any modest association that may exist, particularly at younger ages.
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Affiliation(s)
- J Danesh
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford OX2 6HE
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196
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Abstract
There has been considerable attention in recent years to the intriguing hypothesis that coronary heart disease and other atherosclerotic diseases may be caused by infection with pathogens such as Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus. Supporting this hypothesis are studies that localize bacterial antigens to atherosclerotic plaques and that draw associations of systemic inflammation and chronic infections with coronary disease. Although there are several examples of positive associations of pathogen seropositivity with disease, recent prospective follow-up studies of infection seropositivity have not generally supported these associations. At present, the evidence is insufficient to designate infection as a causal risk factor for coronary heart disease. The results of ongoing larger observational studies and antibiotic treatment trials may yield important information regarding the presence and magnitude of risk, if any, beyond that conferred by established coronary risk factors.
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Affiliation(s)
- C J O'Donnell
- Framingham Heart Study, 5 Thurber Street, Framingham, MA 01702, USA.
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197
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Leinonen M. Chlamydia pneumoniae and other risk factors for atherosclerosis. J Infect Dis 2000; 181 Suppl 3:S414-6. [PMID: 10839726 DOI: 10.1086/315624] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Seroepidemiologic studies have provided information on the association of Chlamydia pneumoniae with the classical risk factors of coronary heart disease (CHD). C. pneumoniae infections are more common in smokers than in nonsmokers, suggesting that smoking predisposes to the development of chronic infection. Infections may also affect lipid metabolism. In persons with acute pneumonia caused by C. pneumoniae, high-density lipoprotein (HDL) values are lower and triglyceride values higher than seen in pneumonia caused by viruses and other bacteria. Furthermore, chronic C. pneumoniae infection is associated with elevated triglyceride and lowered HDL levels in healthy Finnish men. Recent studies also suggest that chronic C. pneumoniae infection considerably enhances the effect of the metabolic syndrome on the CHD risk. Thus, known CHD risk factors may be partly explained by their association with chronic C. pneumoniae infection. Further studies are needed to elucidate the pathogenetic mechanisms underlying these associations.
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Affiliation(s)
- M Leinonen
- National Public Health Institute, Department in Oulu, FIN-90101 Oulu, Finland.
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