Multiple infections and subsequent cardiovascular events in the Heart Outcomes Prevention Evaluation (HOPE) Study.
BACKGROUND
Limited prospective epidemiological data are available on the relation between exposure to Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus (CMV), and hepatitis A virus (HAV), individually or as a total pathogen score, and human cardiovascular (CV) disease.


RESULTS
We analyzed enrollment sera from 3168 Canadian patients in the Heart Outcomes Prevention Evaluation (HOPE) study for antibodies to C pneumoniae, H pylori, CMV, and HAV and measured the relation between serostatus and 494 adjudicated trial outcomes of myocardial infarction, stroke, or CV death over 4.5 years of follow-up. CV events were associated with CMV serostatus (covariate-adjusted hazard ratio [HR], 1.24; 95% CI, 1.01, 1.53). Neither C pneumoniae IgG (adjusted HR, 0.87; 95% CI, 0.68, 1.10), C pneumonia IgA (adjusted HR, 1.10; 95% CI, 0.90, 1.34), H pylori IgG (HR, 0.99; 95% CI, 0.82, 1.19), nor HAV IgG (HR, 1.01; 95% CI, 0.83, 1.24) predicted CV events. Total pathogen score was associated with CV events (adjusted HR for 4 versus 1 or 0=1.41; 95% CI, 1.02, 1.96).


CONCLUSIONS
Exposure to CMV but not to C pneumoniae, H pylori, or HAV was associated with a slight excess risk of subsequent myocardial infarction, stroke, or CV death in HOPE study patients, and total pathogen score based on these infections predicted a small increased hazard of CV events.
Smieja
Marek
M
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
Gnarpe
Judy
J
Lonn
Eva
E
Gnarpe
Håkan
H
Olsson
Gunnar
G
Yi
Qilong
Q
Dzavik
Vladimir
V
McQueen
Matthew
M
Yusuf
Salim
S
D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D023521:Chlamydophila Infections / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D016993:Chlamydophila pneumoniae / Q000276:immunology; D015897:Comorbidity; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D016480:Helicobacter pylori / Q000276:immunology; D006506:Hepatitis A / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D030041:Hepatitis A virus / Q000276:immunology; D006801:Humans; D008297:Male; D016017:Odds Ratio; D018570:Risk Assessment; D016036:Seroepidemiologic Studies; D016019:Survival Analysis
D000907:Antibodies, Bacterial; D000914:Antibodies, Viral