Assessment of systemic inflammation and infective pathogen burden in patients with cardiac syndrome X.
Inflammation plays a key role in coronary artery disease (CAD), but whether it is involved in the pathogenesis of syndrome X (SX) is not known. Thus, we assessed the presence of systemic inflammation in patients with SX and its possible relation to infections from Helicobacter pylori, Chlamydia pneumoniae, cytomegalovirus, and Epstein-Barr virus. We studied 55 patients with SX (57 +/- 8 years old; 27 women), 49 with stable angina and obstructive CAD (56 +/- 8 years old; 24 women), and 60 healthy controls (57 +/- 11 years old; 24 women). Plasma levels of high-sensitivity C-reactive protein and interleukin-1 receptor antagonist were measured in all patients. Infection from Helicobacter pylori, Chlamydia pneumoniae, cytomegalovirus, and Epstein-Barr virus was assessed in 43 patients with SX, 40 patients with CAD, and in 39 controls. Patients with SX had lower serum levels of C-reactive protein than did patients with CAD (4.06 +/- 6.8 vs 5.99 +/- 7.8 mg/L, p = 0.013) but higher levels of C-reactive protein than did controls (1.75 +/- 1.98 mg/L; p = 0.008). Plasma levels of interleukin-1 receptor antagonist were higher in patients with CAD (570 +/- 738 pg/ml) and patients with SX (494 +/- 677 pg/ml) than in controls (254 +/- 174, pg/ml; p = 0.0003 vs CAD and p = 0.013 vs SX) but did not differ significantly between patients with CAD or SX (p = 0.20). There were no differences across groups in the prevalence of infection from Helicobacter pylori, Chlamydia pneumoniae, cytomegalovirus, and Epstein-Barr virus and in the prevalence of 1, 2, 3, and 4 infections (p = 0.99). Among patients with SX, no correlation was found between markers of inflammation and indexes of disease activity (angina episodes, exercise test results). Our data show evidence of increased low-grade systemic inflammation in patients with cardiac SX, which was unrelated to an increased infectious pathogen burden.
Lanza
Gaetano Antonio
GA
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy. g.a.lanza@inwind.it
Sestito
Alfonso
A
Cammarota
Giovanni
G
Grillo
Rita Luciana
RL
Vecile
Elena
E
Cianci
Rossella
R
Speziale
Domenico
D
Dobrina
Aldo
A
Maseri
Attilio
A
Crea
Filippo
F
D002097:C-Reactive Protein; D016022:Case-Control Studies; D002690:Chlamydia Infections / Q000150:complications / Q000453:epidemiology; D016993:Chlamydophila pneumoniae; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications; D003586:Cytomegalovirus Infections / Q000150:complications / Q000453:epidemiology; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000453:epidemiology; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D007558:Italy / Q000453:epidemiology; D008297:Male; D017566:Microvascular Angina / Q000097:blood* / Q000150:complications; D008875:Middle Aged; D015995:Prevalence
D002097:C-Reactive Protein