Cytomegalovirus in the pathogenesis of atherosclerosis
The role of inflammation as reflected by elevated C-reactive protein levels
Jianhui Zhu, MD, PhD*,
Arshed A. Quyyumi, MD, FACC ,
James E. Norman, PhD ,
Gyorgy Csako, MD and
Stephen E. Epstein, MD, FACC*
* Cardiovascular Research Foundation, Washington Hospital Center, Washington, DC, USA
Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
National Institutes of Health, Bethesda, Maryland, USA
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Figure 1 (A) Mean levels of CRP in patients with CAD and in patients without coronary artery disease (CAD). Mean CRP values (mg/dl ± SE) are shown. (B) Prevalence of high CRP levels (>0.5 mg/dl) in patients with CAD and in patients without CAD. CAD+: presence of CAD; CAD–: absence of CAD; CRP: C-reactive protein.
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Figure 2 Prevalence of seropositivity to CMV in patients with CAD and in patients without CAD. CAD+: presence of CAD; CAD–: absence of CAD.
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Figure 3 Prevalence of CAD among subgroups with variation in inflammation and CMV infection. When adjustment for CAD risk factors, the odds ratios for CAD were 1.3 (95% CI, 0.4 to 4.4; p = 0.7) in the subgroup with CMV seropositivity alone, 2.3 (95% CI, 0.7 to 7.5; p = 0.2) in the subgroup with elevated CRP levels alone, and 4.3 (95% CI, 1.4 to 13.1; p = 0.01) in the subgroup with combined CMV seropositivity and elevated CRP levels. Overall liner trend achieves significance even after adjustment for CAD risk factors (p = 0.0016). CMV Ab+ or CMV Ab–: CMV antibody response positive or negative, respectively; CRP >0.5+ or CRP >0.5–: CRP levels >0.5 mg/dl or CRP levels  0.5 mg/dl, respectively.
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