Published online before print November 10, 2003, doi: 10.1161/01.CIR.0000102380.47012.92
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(Circulation. 2003;108:2730.)
© 2003 American Heart Association, Inc.
Review: Current Perspective |
Influenza and Cardiovascular Disease
A New Opportunity for Prevention and the Need for Further Studies
From the Department of Internal Medicine/Division of Cardiology (M.M., M.N., S.W.C.), Department of Pathology (S.L.), School of Medicine, University of Texas-Houston Health Science Center, and Texas Heart Institute (M.M., M.N., S.L., S.W.C.), Houston, Tex.
Correspondence to Ward Casscells, MD, 6431 Fannin, MSB 1.254, Houston, TX 77030. E-mail S.Ward.Casscells@uth.tmc.edu
Key Words: infection • myocardial infarction • atherosclerosis • prevention • heart diseases
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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In the United States, 12 400 000 people live with a history of heart attack, angina pectoris, or both. Of this population, an estimated 1 100 000 will suffer a new or recurrent coronary attack this year.1 According to the World Health Organization, cardiovascular disease (CVD) will be the leading cause of death worldwide by 2020.2
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Infections and Atherosclerosis |
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Infectious agents have been implicated in the etiology of atherosclerosis and its complications since the early 1900s.3 Clinicians have long noticed that
30% of myocardial infarctions (MIs) are preceded by an upper respiratory infection.4,5 Agents implicated in atherosclerosis include cytomegalovirus (CMV), Chlamydia pneumoniae, Herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), Helicobacter pylori, Mycoplasma pneumoniae, Porphyromonas gingivalis, and Enterovirus.6–13 Antibiotic therapy for C. pneumoniae in CVD patients has been tried with transient or no benefit to date.14,15 Ongoing studies may give a definitive answer by late 2003.16
Here, we review recent studies suggesting influenza may play a role in atherogenesis or atherothrombosis. In 2000, we reported a case-control study in patients with known coronary artery disease; influenza vaccination was associated with a 67% reduction (OR 0.33, 95% CI 0.13 to 0.82, P=0.017) in risk of MI in the subsequent influenza season.17 In a simultaneous population-based case-control study, Siscovick et al18 found that after adjusting for demographic, clinical, and behavioral risk factors, influenza vaccination was associated with a 49% reduction (OR 0.51, 95% CI 0.33 to 0.79) in risk of out-of-hospital primary cardiac arrest. Another case-control study reported a
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