LETTER TO THE EDITOR
Cytokine gene polymorphisms and development of CAD associated with CP infection
Johann Auer, MDa,
Robert Berent, MDa,
Thomas Weber, MDa and
Bernd Eber, MDa
a Department of Cardiology and Intensive Care, General Hospital Wels, Grieskirchnerstrasse 42, A-4600 Wels, Austria
johann.auer{at}khwels.at
We read with great interest the study by Momiyama et al. (1) in a recent issue of the Journal. The study reports that cytokine gene polymorphisms, in particular interleukin-1 (IL-1) polymorphisms, play a role in the development of coronary artery disease (CAD) in patients with Chlamydia pneumoniae (CP) infection. Moreover, they found that CP seropositivity was not significantly different between patients with and without CAD. Momiyama et al. (1) suggested that "triggers" such as IL-1 gene polymorphisms could influence the effect of such infectious agents as CP on development of CAD.
Increasing evidence exists indicating that inflammation plays an important role in atherogenesis (2). The hypothesis of infectious agents that might play an important role in the atherogenesis is supported by results of several epidemiologic studies suggesting possible atherogenic potential not only from CP (3) but also from such pathogens as cyotmegalovirus (4), herpes simplex virus (HSV) (5) and Helicobacter pylori (6).
However, existing epidemiologic data about the association of some of these pathogens and atherosclerosis are conflicting (7). We support the finding of Momiyama et al. (1) that that CP seropositivity is not associated with CAD by data from 218 consecutive patients undergoing coronary angiography. Blood of all subjects was tested for serum IgG antibodies to CP and for seromarkers of five other pathogens (hepatitis A-virus, Helicobacter pylori, HSV, influenza type A and influenza type B). Of the 218 patients, 88 (40.4%) had anti-CP IgG antibodies. The CAD prevalence was 61.4% in CP-seropositive and 66.9% in CP-seronegative patients (p = 0.49). Moreover, seropositivity for each other pathogen (tested in our study) was not associated with CAD.
In contrast, the number of infectious pathogens to which an individual has been exposed (8) ("infectious burden") correlates with prevalence of CAD. Four or more of the six seromarkers tested for particular infections were positive in 48.8% of patients with CAD and in 31.2% of patients in patients without CAD (p = 0.02). Therefore, our data support the results from Momiyama et al. (1) that seropositivity for a particular infectious agent, like CP, represents no predictor of risk for CAD. However, some "triggers," such as cytokine gene polymorphisms or additional exposure to other pathogens, could influence the susceptibility to the atherogenic effect of infection with a particular pathogen like CP. Consequently, this finding suggests that "susceptibility" factors could make subjects more likely to develop CAD when infected with a particular pathogenic agent.
 |
References
|
|---|
- Momiyama Y, Hirano R, Taniguchi H, Nakamura H, Ohsuzu F. Effects of interleukin-1 gene polymorphisms on the development of coronary artery disease associated with Clamydia pneumoniae infection. J Am Coll Cardiol. 2001;38:712–717[Abstract/Free Full Text]
- Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med. 1999;340:115–116[Free Full Text]
- Saikku P, Leinonen M, Tenkanen L, et al. Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study. Ann Intern Med. 1992;116:273–278[Medline]
- Zhu J, Quyyumi AA, Norman JE, Csako G, Epstein SE. Cytomegalovirus in the pathogenesis of atherosclerosis: the role of inflammation as reflected by elevated C-reactive protein levels. J Am Coll Cardiol. 1999;34:1738–1743[Abstract/Free Full Text]
- Ridker PM, Hennekens CH, Stampfer MJ, et al. Prospective study of herpes simplex virus, cytomegalovirus, and the risk of future myocardial infarction and stroke. Circulation. 1998;98:2796–2799[Abstract/Free Full Text]
- Pasceri V, Cammarota G, Patti G. Association of virulent Helicobacter pylori strains with ischemic heart disease. Circulation. 1998;97:1675–1679[Abstract/Free Full Text]
- Wald NJ, Law MR, Morris JK, Bagnall AM. Helicobacter pylori infection and mortality from ischaemic heart disease: negative result from a large, prospective study. BMJ. 1997;315:1199–1201[Abstract/Free Full Text]
- Rupprecht HJ, Blankenberg S, Bickel C, et al. Impact of viral and bacterial infectious burden on long-term prognosis in patients with coronary artery disease. Circulation. 2001;104:25–31[Abstract/Free Full Text]
Top
References