Infectious risk factors for atherosclerotic vascular disease in hemodialysis patients--Chlamydia pneumoniae but not Helicobacter pylori or cytomegalovirus is associated with increased C-reactive protein.
BACKGROUND
Cardiovascular disease is a major problem in patients with chronic renal failure leading to increased mortality. Several infectious agents have been implicated to be associated with atherosclerosis. We were interested to evaluate whether there is a correlation between a past infection with Chlamydia pneumoniae (Cpn), Helicobacter pylori (Hp) or cytomegalovirus (CMV) and the manifestation of a symptomatic atherosclerotic disease in patients with endstage renal failure.


RESULTS
Patients (n=267) on hemodialysis were investigated. In 101 patients with an apparent atherosclerotic disease (case group) increased IgA levels against Cpn were found (p < or = 0.0001 vs. controls; n=33). Nearly 45% of the case group had a history of myocardial infarction (MI) (p < or = 0.0001). Prior stroke was found in about 30% of patients in the case group (p < or = 0.002). Elevated CRP levels were identified as an independent risk factor for atherosclerosis in all groups. IgA seropositivity against Cpn correlated with elevated CRP values for all atherosclerotic patients (p < or = 0.001), especially in the group of patients with MI (p < or = 0.019) and peripheral vascular disease (p < or = 0.005). There was no correlation between CMV (IgG, IgM) or Hp (IgA, IgG) seropositivity and atherosclerotic disease.


CONCLUSIONS
IgA seropositivity for Cpn and elevated CRP values but not Hp or CMV was associated with an increased rate of symptomatic atherosclerotic manifestations as MI, stroke, cerebral or peripheral atherosclerosis in patients with endstage renal disease on hemodialysis.
Wolf
Sabine C
SC
Department of Cardiology and Nephrology, Medical Clinic III, University of Tübingen, Tübingen, Germany. sabine.wolf@med.uni-tuebingen.de
Brehm
Bernhard R
BR
Mayer
Oliver
O
Jürgens
Stefan
S
Schultze
Georg
G
Risler
Teut
T
D000368:Aged; D001161:Arteriosclerosis / Q000453:epidemiology / Q000382:microbiology*; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D023521:Chlamydophila Infections / Q000453:epidemiology*; D016993:Chlamydophila pneumoniae / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D006435:Renal Dialysis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology
D007070:Immunoglobulin A; D002097:C-Reactive Protein