Published online before print May 12, 2003, doi: 10.1161/01.CIR.0000068338.17948.22
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(Circulation. 2003;107:2566.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Synergistic Effect of Persistent Chlamydia pneumoniae Infection, Autoimmunity, and Inflammation on Coronary Risk
From the National Public Health Institute, Oulu (T.H., M.L.) and Helsinki (T.P.); the Helsinki Heart Study (L.T., H.V.) and the Department of Medicine, Helsinki University Central Hospital (M.M., V.M.), Helsinki; and the Department of Medical Microbiology, University of Oulu, Oulu (P.S.), Finland.
Correspondence to Tiina Huittinen, National Public Health Institute, Aapistie 1, PO box 310, FIN-90101 Oulu, Finland. E-mail tiina.huittinen{at}ktl.fi
Background— Given the role of chronic infections, autoimmunity, and inflammation in atherosclerosis, we studied the joint effect of chronic Chlamydia pneumoniae infection, persistently elevated human heat-shock protein 60 (hHsp60) antibodies, and C-reactive protein (CRP) on coronary risk.
Methods and Results— The participants for this prospective nested case-control study were obtained from the Helsinki Heart Study, during which 241 nonfatal myocardial infarctions or coronary deaths occurred among 4081 dyslipidemic middle-aged men. Serum samples taken at baseline and 3 to 6 months before the coronary events that occurred during the 8.5-year period were analyzed for antibodies to C pneumoniae and hHsp60 and the CRP concentration. Compared with persistently low levels, the risk of coronary events was 2-fold for persistently elevated immunocomplex (IC)-bound and/or serum IgA antibodies to C pneumoniae (OR, 1.96; 95% CI, 1.14 to 3.36) and also for serum IgA antibodies to hHsp60 (OR, 2.11; 95% CI, 1.08 to 4.13). The risks associated with elevated antibodies were much higher when CRP was also elevated. Compared with low or transiently elevated levels, the risk of coronary events, with adjustment for age and smoking, was 4.5-fold for persistently elevated CRP and C pneumoniae IC/IgA antibodies together (OR, 4.47; 95% CI, 1.84 to 10.83) and was similar for CRP and hHsp60 IgA antibodies together (OR, 4.36; 95% CI, 1.53 to 12.39).
Conclusions— Persistently but not transiently elevated C pneumoniae IC/IgA and hHsp60 IgA antibodies, especially when present together with an elevated CRP level, predicted coronary events.
Key Words: coronary disease • risk factors • infection • inflammation
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