title: Multiple infections and subsequent cardiovascular events in the Heart Outcomes Prevention Evaluation (HOPE) Study.
abstract: 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.
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Marek
authors.initials: M
authors.lastname: Smieja
authors.forename: Judy
authors.initials: J
authors.lastname: Gnarpe
authors.forename: Eva
authors.initials: E
authors.lastname: Lonn
authors.forename: Håkan
authors.initials: H
authors.lastname: Gnarpe
authors.forename: Gunnar
authors.initials: G
authors.lastname: Olsson
authors.forename: Qilong
authors.initials: Q
authors.lastname: Yi
authors.forename: Vladimir
authors.initials: V
authors.lastname: Dzavik
authors.forename: Matthew
authors.initials: M
authors.lastname: McQueen
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: 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
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral