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CLINICAL STUDY

Lack of association between Chlamydia pneumoniae seropositivity and aortic atherosclerotic plaques

A Population-Based transesophageal echocardiographic study

Yoram Agmon, MD^*, Bijoy K. Khandheria, MD, FACC^*,*, Irene Meissner, MD, Tanya M. Petterson, MS, W. Michael O’Fallon, PhD, Teresa J. H. Christianson, BS, David O. Wiebers, MD, Thomas F. Smith, PhD, James M. Steckelberg, MD^|| and A. Jamil Tajik, MD, FACC^*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
^|| Division of Infectious Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received April 23, 2002; revised manuscript received January 16, 2003, accepted January 24, 2003.

^* Reprint requests and correspondence: Dr. Bijoy K. Khandheria, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
khandheria{at}mayo.edu

OBJECTIVES: The objective of this study was to examine the relationship between Chlamydia pneumoniae seropositivity and aortic atherosclerotic plaques in the general population.

BACKGROUND: Seroepidemiologic studies suggest that C pneumoniae infection plays a role in the pathogenesis of atherosclerosis.

METHODS: Transesophageal echocardiography was performed in 385 subjects (median age 66 years, range 51 to 101 years; 53% men), a sample of the Olmsted County (Minnesota) population. The association between C pneumoniae immunoglobulin (Ig) G antibody titers and aortic atherosclerotic plaques was examined.

RESULTS: Chlamydia pneumoniae IgG antibodies (titers 1:16) were detected in 287 subjects (74.5%): low titers (1:16 to 1:32) in 58 (15.1%), intermediate titers (1:64 to 1:128) in 144 (37.4%), and high titers (1:256) in 85 subjects (22.1%). Antibody titers were not associated with the presence of aortic plaques after adjustment for age, gender, and smoking status (p = 0.64). Compared with titers <1:16, the adjusted odds ratios for aortic plaques were 1.46 (95% confidence interval [CI] 0.63 to 3.42) for low titers, 1.32 (95% CI 0.68 to 2.55) for intermediate titers, and 0.94 (95% CI 0.42 to 2.07) for high titers. Among the subgroup with plaques, antibody titers were not associated with the presence of plaques 4 mm thick (p = 0.99), plaques 6 mm (p = 0.49), or mobile debris (p = 0.71), after adjustment for age and smoking.

CONCLUSIONS: Chlamydia pneumoniae IgG antibody titers are not associated with the presence or severity of aortic atherosclerosis in the general population. These observations do not support a role for C pneumoniae infection in the initiation or progression of atherosclerosis.

Abbreviations and Acronyms   CI = confidence interval   hs-CRP = high-sensitivity C-reactive protein   Ig = immunoglobulin   OR = odds ratio   SPARC = Stroke Prevention: Assessment of Riskin a Community   TEE = transesophageal echocardiography