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(Circulation. 1998;98:628-633.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Confirmed Previous Infection With Chlamydia pneumoniae (TWAR) and Its Presence in Early Coronary Atherosclerosis

Michael Davidson, MD, MPH; Cho-Chou Kuo, MD, PhD; John P. Middaugh, MD; Lee Ann Campbell, PhD; San-Pin Wang, MD, DSc; William P. Newman, III, MD; John C. Finley, MD; ; J. Thomas Grayston, MD

From the Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, Md (M.D.); the Biomedical Program, University of Alaska at Anchorage (M.D.); the Departments of Pathobiology, Epidemiology, and Pathology, University of Washington, Seattle (C.-C.K., L.A.C., S.-P.W., J.T.G.); the State of Alaska, Epidemiology Section, Division of Public Health, Anchorage (J.P.M.); the Department of Pathology, Louisiana State University Medical School, New Orleans (W.P.N.); and the Department of Medicine, Alaska Native Medical Center, Anchorage (J.C.F.).

Background—Chlamydia pneumoniae has been identified in coronary atheroma, but concomitant serum antibody titers have been inconsistently positive and unavailable before the detection of early or advanced atherosclerotic lesions.

Methods and Results—This retrospective investigation was performed on premortem serum specimens and autopsy tissue from 60 indigenous Alaska Natives at low risk for coronary heart disease, selected by the potential availability of their stored specimens. Serum specimens were drawn a mean of 8.8 years (range, 0.7 to 26.2 years) before death, which occurred at a mean age of 34.1 years (range, 15 to 57 years), primarily from noncardiovascular causes (97%). Coronary artery tissues were independently examined histologically and, for C pneumoniae organism and DNA, by immunocytochemistry (ICC) and polymerase chain reaction (PCR) with species-specific monoclonal antibody and primers. Microimmunofluorescence detected species-specific IgG, IgA, and IgM antibody in stored serum. C pneumoniae, frequently within macrophage foam cells, was identified in coronary fibrolipid atheroma (raised lesions, Stary types II through V) in 15 subjects (25%) and early flat lesions in 7 (11%) either by PCR (14, 23%) or ICC (20, 33%). The OR for C pneumoniae in raised atheroma after a level of IgG antibody 1:256 >8 years earlier was 6.1 (95% CI, 1.1 to 36.6) and for all coronary tissues after adjustment for multiple potential confounding variables, including tobacco exposure, was 9.4 (95% CI, 2.6 to 33.8).

Conclusions—Serological evidence for C pneumoniae infection frequently precedes both the earliest and more advanced lesions of coronary atherosclerosis that harbor this intracellular pathogen, suggesting a chronic infection and developmental role in coronary heart disease.

Key Words: Chlamydia pneumoniae • coronary disease • atherosclerosis

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