Meta-analysis of sero-epidemiologic studies of the relation between Chlamydia pneumoniae and atherosclerosis: does study design influence results?
BACKGROUND
The results of sero-epidemiologic studies of the relation between Chlamydia pneumoniae and atherogenesis vary considerably. A meta-analysis was performed to calculate the overall odds ratio (OR) and to identify potential sources of variability.


METHODS
The MEDLINE database was searched from January 1997 to December 2000 for studies describing the seroprevalence of IgG antibodies to C pneumoniae in relation to clinically manifest atherosclerosis. Data extracted included 1) the study design used, 2) the number of included patients, 3) the type of disease (or end point), 4) the number of control subjects, 5) the type of control subjects, 6) the follow-up duration, 7) the crude and adjusted ORs (and 95% CI), and 8) the extent of adjustment for potential confounders.


RESULTS
Thirty-eight studies were included in the meta-analysis. The overall OR was 1.6 (95% CI 1.3-2.0). The overall OR of cross-sectional case-control studies (2.0, 95% CI 1.5-2.6) was higher than that of prospective (nested) case-control studies (1.1, 95% CI 0.8-1.4). Moreover, the duration of follow-up in prospective studies was inversely related to the strength of the relation (beta = -0.04, 95% CI -0.08, -0.01). Adjustment of risk estimates for potentially confounding factors did not influence the strength of the relation.


CONCLUSIONS
The relation between C pneumoniae and clinically manifest atherosclerosis is not durable. This probably is due to a lack of causality, although results may have been influenced by the design of the component studies.
Bloemenkamp
Daisy G M
DG
Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
Mali
Willem P Th M
WP
Visseren
Frank L J
FL
van der Graaf
Yolanda
Y
D001161:Arteriosclerosis / Q000453:epidemiology* / Q000276:immunology; D016022:Case-Control Studies; D002690:Chlamydia Infections / Q000453:epidemiology / Q000276:immunology; D016993:Chlamydophila pneumoniae / Q000276:immunology*; D015897:Comorbidity; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000276:immunology; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000453:epidemiology / Q000276:immunology; D011446:Prospective Studies; D012044:Regression Analysis; D012107:Research Design / Q000592:standards*; D016036:Seroepidemiologic Studies
D007074:Immunoglobulin G