Published online before print December 23, 2002, doi: 10.1161/01.CIR.0000044940.65226.1F
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(Circulation. 2003;107:251.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Multiple Infections and Subsequent Cardiovascular Events in the Heart Outcomes Prevention Evaluation (HOPE) Study
From the Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (M.S., M.M.); the Department of Medicine, McMaster University, Hamilton, Ontario, Canada (M.S., E.L., M.M., S.Y.); the Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada (J.G.); the Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada (Q.Y., S.Y.); the Institute of Medical Sciences, Uppsala University, Uppsala, Sweden (H.G.); the Department of Medicine, Karolinska Hospital, Stockholm, Sweden (G.O.); and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada (V.D.).
Correspondence to Dr Salim Yusuf, Canadian Cardiovascular Collaboration Project Office, Hamilton General Hospital, 237 Barton St East, Hamilton ON L8L 2X2 Canada. E-mail hope{at}ccc.mcmaster.ca
Background— Limited prospective epidemiological data are available on the relation between exposure to Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus (CMV), and hepatitis A virus (HAV), individually or as a total pathogen score, and human cardiovascular (CV) disease.
Methods and Results— We analyzed enrollment sera from 3168 Canadian patients in the Heart Outcomes Prevention Evaluation (HOPE) study for antibodies to C pneumoniae, H pylori, CMV, and HAV and measured the relation between serostatus and 494 adjudicated trial outcomes of myocardial infarction, stroke, or CV death over 4.5 years of follow-up. CV events were associated with CMV serostatus (covariate-adjusted hazard ratio [HR], 1.24; 95% CI, 1.01, 1.53). Neither C pneumoniae IgG (adjusted HR, 0.87; 95% CI, 0.68, 1.10), C pneumonia IgA (adjusted HR, 1.10; 95% CI, 0.90, 1.34), H pylori IgG (HR, 0.99; 95% CI, 0.82, 1.19), nor HAV IgG (HR, 1.01; 95% CI, 0.83, 1.24) predicted CV events. Total pathogen score was associated with CV events (adjusted HR for 4 versus 1 or 0=1.41; 95% CI, 1.02, 1.96).
Conclusions— Exposure to CMV but not to C pneumoniae, H pylori, or HAV was associated with a slight excess risk of subsequent myocardial infarction, stroke, or CV death in HOPE study patients, and total pathogen score based on these infections predicted a small increased hazard of CV events.
Key Words: infection • cardiovascular diseases • prognosis
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