title: Impact of infectious burden on progression of carotid atherosclerosis.
abstract: OBJECTIVE
  Recent findings suggest a causative role of infections in the pathogenesis of atherosclerosis. The extent of atherosclerosis and the prognosis of patients with atherosclerosis seem to be increased by the number of infections to which an individual has been exposed. In a prospective study, we evaluated the effect of 8 pathogens and the aggregate pathogen burden on the progression of carotid atherosclerosis.
  
  
  METHODS
  In 504 patients (74.9% men; age, 62.9+/-10 years), we measured intima-media thickness and prevalence of carotid artery stenosis. Follow-up measurements after a mean of 2.5 years were available in 427 patients (85%). Blood samples were taken, and IgG or IgA antibodies to Chlamydia pneumoniae, Helicobacter pylori, Haemophilus influenzae, Mycoplasma pneumoniae, cytomegalovirus, Epstein-Barr virus, and herpes simplex virus types 1 and 2 were measured. Statistical evaluation was performed with logistic regression procedures.
  
  
  RESULTS
  Elevated IgA antibodies against C pneumoniae (P<0.04) and IgG antibodies against Epstein-Barr virus (P<0.01) and herpes simplex virus type 2 (P<0.04) were associated with progression of atherosclerosis (increase of intima-media thickness > or =0.1 mm/y or progression of carotid stenosis) after adjustment for age, sex, cardiovascular risk factors, highly sensitive C-reactive protein, and statin intake. Infectious burden, divided into 0 to 3, 4 to 5, and 6 to 8 seropositivities, was significantly associated with progression of atherosclerosis, with odds ratios of 1.8 (95% confidence interval, 1.1 to 2.9) for 4 to 5 and 3.8 (95% CI, 1.6 to 8.8) for 6 to 8 compared with 0 to 3 seropositivities after adjustment.
  
  
  CONCLUSIONS
  Our results support the hypothesis that the number of infectious pathogens to which an individual has been exposed independently contributes to the progression of carotid atherosclerosis.
authors.affiliation: Department of Medicine II, Johannes Gutenberg University Mainz, Germany. espinola@mail.uni-mainz.de
authors.forename: Christine
authors.initials: C
authors.lastname: Espinola-Klein
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Rupprecht
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
authors.forename: Helmuth
authors.initials: H
authors.lastname: Kopp
authors.forename: Anja
authors.initials: A
authors.lastname: Victor
authors.forename: Gerd
authors.initials: G
authors.lastname: Hafner
authors.forename: Wilfried
authors.initials: W
authors.lastname: Prellwitz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schlumberger
authors.forename: Jürgen
authors.initials: J
authors.lastname: Meyer
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D023521:Chlamydophila Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D015897:Comorbidity; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D018450:Disease Progression; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006192:Haemophilus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D016481:Helicobacter Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D006561:Herpes Simplex / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009175:Mycoplasma Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D016036:Seroepidemiologic Studies; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D007070:Immunoglobulin A; D007074:Immunoglobulin G