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J Am Coll Cardiol, 1998; 32:35-41
© 1998 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Evaluation of C-reactive protein, an inflammatory marker, and infectious serology as risk factors for coronary artery disease and myocardial infarction

Jeffrey L. Anderson, MD, FACCa,b, John F. Carlquist, PhDa,b, Joseph B. Muhlestein, MD, FACCa,b, Benjamin D. Horne, BSa,b and Sidney P. Elmer, BSa,b

a University of Utah School of Medicine, Departments of Internal Medicine and Pathology, Salt Lake City, Utah, USA
b LDS Hospital, Salt Lake City, Utah, USA

Manuscript received October 27, 1997; revised manuscript received March 5, 1998, accepted March 16, 1998.

Present address and address for correspondence: Dr. Jeffrey L. Anderson, Merck & Co., Inc., P.O. Box 4, BL 3-1, West Point, Pennsylvania 19486
jeffrey_anderson{at}merck.com

Objectives. We sought to test whether C-reactive protein (CRP) and seropositivity to any of three infectious agents are associated with angiographic coronary artery disease (CAD) and clinical myocardial infarction (MI).

Background. CRP, an inflammatory marker, is reported to predict risk of MI. The stimulus for CRP is unknown but might include infection. Chlamydia pneumoniae, cytomegalovirus and Helicobacter pylori have been linked to risk of MI or CAD.

Methods. Blood samples were collected from 363 patients undergoing coronary arteriography and tested for CRP and IgG titers to the infectious agents.

Results. CRP was higher in patients with CAD (1.32 mg/dl [SE 0.22, n = 80] vs. 0.58 mg/dl [SE 0.11 mg/dl, n = 109], p = 0.004) and in those with MI (2.05 mg/dl [SE 0.36, n = 47] vs. 0.54 mg/dl [SE 0.08, n = 133], p = 0.0002) than in respective control subjects. Seropositivity for each agent was present in a high proportion of patients with CAD (58% to 77%) or MI (54% to 75%) as well as in control subjects (no CAD: 46% to 74%; no MI: 50% to 77%). However, subjects seropositive to both C. pneumoniae and H. pylori had an increased prevalence of CAD (odds ratio [OR] 2.6, p = 0.02) and MI (OR 2.0, p = 0.15) and tended to have higher CRP levels (1.07 mg/dl [SE 0.16]) than those seronegative to both infectious agents (0.53 mg/dl [SE 0.10], p = 0.06).

Conclusions. CRP is elevated in patients with CAD (more than twofold) and in those with MI (fourfold). Infectious serology is highly prevalent in both patients and control subjects. Seropositivity to both C. pneumoniae and H. pylori (but not one agent alone) may predict increased risk and may be associated with higher CRP levels. Infectious serology may be less predictive than previously suggested, but the cause of inflammation in CAD and MI deserves further study.

Abbreviations and Acronyms
  CAD = coronary artery disease
  CMV = cytomegalovirus
  CRP = C-reactive protein
  LDL = low density lipoprotein
  MI = myocardial infarction
  OR = odds ratio




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