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CLINICAL STUDY: INFECTIONS AND CARDIOVASCULAR DISEASE

The association of seropositivity to Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus with risk of cardiovascular disease

A prospective study

Agha W. Haider, MD, PhD^*, Peter W. F. Wilson, MD^*, Martin G. Larson, DSc^*, Jane C. Evans, PhD^*, Eric L. Michelson, MDFACC^||, Philip A. Wolf, MD, Christopher J. O’Donnell, MDFACC^* and Daniel Levy, MDFACC^*¶,*

^* National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Section of Epidemiology and Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
Cardiology Division, MCP Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
^|| AstraZeneca, Wayne, Pennsylvania, USA
^¶ Divisions of Cardiology and Clinical Epidemiology, Beth Israel Hospital, Boston, Massachusetts, USA

Manuscript received September 19, 2000; revised manuscript received June 3, 2002, accepted July 2, 2002.

^* Reprint requests and correspondence: Dr. Daniel Levy, Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, Massachusetts 01702-5827, USA.

OBJECTIVES: We sought to determine whether seropositivity to Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus (CMV) is an independent predictor of incident cardiovascular disease.

BACKGROUND: Recent reports have suggested that infections may contribute to risk of cardiovascular disease. However, prospective studies of these associations in a free-living population are lacking.

METHODS: We measured serum H. pylori IgG, C. pneumoniae IgG and IgA, and CMV IgG levels in Framingham Heart Study cohort participants. Blood samples were drawn during the 16th biennial examination cycle (1979 to 1982) from 1,187 participants free of cardiovascular disease (mean age 69 years) and stored at –20°C. A pooled primary end point of myocardial infarction, atherothrombotic stroke, and coronary heart disease deaths was studied in relation to serology. Using a Cox model, hazard ratios (HR) and 95% confidence intervals (CI) were calculated, adjusting for age, gender, and established risk factors.

RESULTS: Seropositivity to H. pylori IgG, C. pneumoniae IgG, C. pneumoniae IgA, and CMV IgG was 60%, 45%, 11%, and 69%, respectively. During 10 years of follow-up, incident cardiovascular disease occurred in 199 participants (16.8%). In age- and gender-adjusted models, H. pylori IgG (HR 1.09, 95% CI 0.81 to 1.46), C. pneumoniae IgG (HR 0.91, 95% CI 0.68 to 1.20), C. pneumoniae IgA (HR 0.65, 95% CI 0.39 to 1.07), and CMV IgG (HR 0.84, 95% CI 0.62 to 1.12) were not associated with incident cardiovascular disease. These associations were further attenuated after adjustment for risk factors including body mass index, total and high-density lipoprotein cholesterol, diabetes mellitus, smoking, and hypertension. These estimates did not change for the individual components of cardiovascular disease, and seropositivity to more than one organism did not alter these risk estimates substantially.

CONCLUSIONS: In this elderly cohort, chronic H. pylori, C. pneumoniae, and CMV infections, as evidenced by seropositivity, were not associated with increased risk for cardiovascular disease. Additional studies are needed to determine the relations of chronic infections to cardiovascular disease risk in younger persons.

Abbreviations and Acronyms   CI   confidence interval   CMV   cytomegalovirus   HDL   high-density lipoprotein   HR   hazard ratio   MI   myocardial infarction

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