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Relationship between infectious burden, systemic inflammatory response, and risk of stable coronary artery disease: role of confounding and reference group

Rothenbacher, D; Brenner, H; Hoffmeister, A; Mertens, T; Persson, Kenneth LU and Koenig, W (2003) In Atherosclerosis 170(2). p.339-345
Abstract
Aim: The purpose of the study was to assess the association between seropositivity to various infectious agents and stable coronary artery disease (CAD), controlling simultaneously for a variety of potential confounders. We also investigated whether the choice of a larger reference group might affect the results, and whether or not seropositivity to multiple agents was associated with a systemic inflammatory response. Methods: We assessed the simultaneous prevalence of antibodies against Helicobacter pylori, Chlamydia, cytomegalovirus, and herpes simplex virus in 312 patients with angiographically proven coronary artery disease (CAD) and in 479 age and sex matched controls. C-reactive protein, interleukin-6, fibrinogen, PAI- I -activity,... (More)
Aim: The purpose of the study was to assess the association between seropositivity to various infectious agents and stable coronary artery disease (CAD), controlling simultaneously for a variety of potential confounders. We also investigated whether the choice of a larger reference group might affect the results, and whether or not seropositivity to multiple agents was associated with a systemic inflammatory response. Methods: We assessed the simultaneous prevalence of antibodies against Helicobacter pylori, Chlamydia, cytomegalovirus, and herpes simplex virus in 312 patients with angiographically proven coronary artery disease (CAD) and in 479 age and sex matched controls. C-reactive protein, interleukin-6, fibrinogen, PAI- I -activity, D-dimer, von Willebrand Factor, plasma viscosity, and a complete blood cell count were determined in all subjects. Results: Seropositivity to all of the four agents was 21.8% in cases and 13.6% in controls (P = 0.0003). We found a dose-response relationship between combined IgG-seropositivity to H. pylori, Chlamydia, cytomegalovirus, and herpes simplex virus and odds for the presence of angiographically confirmed stable CAD which, however, was strongly reduced after controlling for a variety of potential confounders. The dose-response pattern was no longer evident if a more stable reference group (subjects seropositive for two agents) was used instead of the relatively small reference group with zero or one seropositivity. We found no consistent pattern between IgG-seropositivity to several pathogens and inflammatory markers. Conclusions: Based on serological evidence of various infectious agents, this study suggests that the aggregate number of persistent infections is not independently associated with an increased risk for CAD if control for confounding and use of a stable reference group are guaranteed. (C) 2003 Published by Elsevier Ireland Ltd. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
coronary artery disease, seropositivity, multiple infections, inflammation, case-control study
in
Atherosclerosis
volume
170
issue
2
pages
339 - 345
publisher
Elsevier
external identifiers
  • pmid:14612216
  • wos:000186850000019
  • scopus:0242409595
ISSN
1879-1484
DOI
10.1016/S0021-9150(03)00300-9
language
English
LU publication?
yes
id
ccff3f09-750c-47f5-b48d-801facf257ca (old id 294688)
date added to LUP
2007-09-20 18:53:20
date last changed
2018-01-07 06:17:19
@article{ccff3f09-750c-47f5-b48d-801facf257ca,
  abstract     = {Aim: The purpose of the study was to assess the association between seropositivity to various infectious agents and stable coronary artery disease (CAD), controlling simultaneously for a variety of potential confounders. We also investigated whether the choice of a larger reference group might affect the results, and whether or not seropositivity to multiple agents was associated with a systemic inflammatory response. Methods: We assessed the simultaneous prevalence of antibodies against Helicobacter pylori, Chlamydia, cytomegalovirus, and herpes simplex virus in 312 patients with angiographically proven coronary artery disease (CAD) and in 479 age and sex matched controls. C-reactive protein, interleukin-6, fibrinogen, PAI- I -activity, D-dimer, von Willebrand Factor, plasma viscosity, and a complete blood cell count were determined in all subjects. Results: Seropositivity to all of the four agents was 21.8% in cases and 13.6% in controls (P = 0.0003). We found a dose-response relationship between combined IgG-seropositivity to H. pylori, Chlamydia, cytomegalovirus, and herpes simplex virus and odds for the presence of angiographically confirmed stable CAD which, however, was strongly reduced after controlling for a variety of potential confounders. The dose-response pattern was no longer evident if a more stable reference group (subjects seropositive for two agents) was used instead of the relatively small reference group with zero or one seropositivity. We found no consistent pattern between IgG-seropositivity to several pathogens and inflammatory markers. Conclusions: Based on serological evidence of various infectious agents, this study suggests that the aggregate number of persistent infections is not independently associated with an increased risk for CAD if control for confounding and use of a stable reference group are guaranteed. (C) 2003 Published by Elsevier Ireland Ltd.},
  author       = {Rothenbacher, D and Brenner, H and Hoffmeister, A and Mertens, T and Persson, Kenneth and Koenig, W},
  issn         = {1879-1484},
  keyword      = {coronary artery disease,seropositivity,multiple infections,inflammation,case-control study},
  language     = {eng},
  number       = {2},
  pages        = {339--345},
  publisher    = {Elsevier},
  series       = {Atherosclerosis},
  title        = {Relationship between infectious burden, systemic inflammatory response, and risk of stable coronary artery disease: role of confounding and reference group},
  url          = {http://dx.doi.org/10.1016/S0021-9150(03)00300-9},
  volume       = {170},
  year         = {2003},
}