title: Prospective study of pathogen burden and risk of myocardial infarction or death.
abstract: BACKGROUND
  We previously demonstrated that the risk of coronary artery disease (CAD) increased in relation to the number of pathogens (the "pathogen burden") in a cross-sectional study. In the present prospective study with a different patient cohort, we evaluated the effect of pathogen burden on the risk of myocardial infarction (MI) or death among CAD patients.
  
  
  RESULTS
  IgG antibodies to cytomegalovirus (CMV), hepatitis A virus (HAV), herpes simplex virus type 1 (HSV1), HSV type 2 (HSV2), Chlamydia pneumoniae and Helicobacter pylori, and C-reactive protein (CRP) levels were tested in baseline blood samples from 890 patients who had significant CAD on angiography. The mean follow-up period was 3 years. The baseline prevalence of antibodies directed against CMV, HAV, HSV1, or HSV2, but not C pneumoniae and H pylori, was significantly higher among patients who subsequently developed MI or death than among control subjects. After adjustment for traditional risk factors, number of diseased vessels, and clinical presentation, relative hazards (95% confidence limits) for MI or death were 2.0 (1. 4 to 3.2) for CMV, 1.6 (1.1 to 2.3) for HAV, and 1.5 (1.0 to 2.2) for HSV2. Increasing pathogen burden was significantly associated with increasing risk of MI or death in a dose-response fashion. Adjusted relative hazards of MI or death associated with pathogen burden were significant among individuals with low or high CRP levels.
  
  
  CONCLUSIONS
  The results suggest that infection plays an important role in incident MI or death and that the risk posed by infection is independently related to the pathogen burden.
authors.affiliation: Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
authors.forename: J
authors.initials: J
authors.lastname: Zhu
authors.forename: F J
authors.initials: FJ
authors.lastname: Nieto
authors.forename: B D
authors.initials: BD
authors.lastname: Horne
authors.forename: J L
authors.initials: JL
authors.lastname: Anderson
authors.forename: J B
authors.initials: JB
authors.lastname: Muhlestein
authors.forename: S E
authors.initials: SE
authors.lastname: Epstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood / Q000276:immunology; D000914:Antibodies, Viral / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism / Q000494:pharmacology; D016993:Chlamydophila pneumoniae / Q000276:immunology; D015331:Cohort Studies; D017023:Coronary Angiography; D003586:Cytomegalovirus Infections / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000097:blood / Q000276:immunology; D016480:Helicobacter pylori / Q000276:immunology; D006506:Hepatitis A / Q000097:blood / Q000276:immunology; D017957:Hepatitis A Virus, Human / Q000276:immunology; D006566:Herpesviridae Infections / Q000097:blood / Q000276:immunology; D018259:Herpesvirus 1, Human / Q000276:immunology; D018258:Herpesvirus 2, Human / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging / Q000276:immunology / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016036:Seroepidemiologic Studies
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D007074:Immunoglobulin G; D002097:C-Reactive Protein