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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

View larger version (12K): [in a new window]   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.

View larger version (12K): [in a new window]   Figure 2 Prevalence of seropositivity to CMV in patients with CAD and in patients without CAD. CAD+: presence of CAD; CAD–: absence of CAD.

View larger version (12K): [in a new window]   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.