title: Role of cytomegalovirus sero-status in the development of secondary cardiovascular events in patients with coronary heart disease under special consideration of diabetes.
abstract: OBJECTIVE
  We investigated prospectively the role of cytomegalovirus (CMV) sero-status in the development of secondary cardiovascular disease (CVD) events in patients with coronary heart disease (CHD) under special consideration of diabetes mellitus.
  
  
  BACKGROUND
  There have been suggestions of an association between cytomegalovirus infection sero-status and development of secondary cardiovascular events. Patients with diabetes might be at higher risk since they are relatively immunocompromised.
  
  
  METHODS
  Patients aged 30-70 undergoing an in-patient rehabilitation program after acute manifestation of coronary heart disease between January 1999 and May 2000 were included in this analysis. CMV status at baseline was measured by serum immunoglobulin G antibodies. Secondary CVD events (myocardial infarction, stroke, and cardiovascular death) were recorded during a mean follow-up period of 33.5 months.
  
  
  RESULTS
  Among the 1033 subjects with measured IgG antibody for CMV, 56.5% were sero-positive to CMV at baseline. During follow-up, secondary CVD events occurred among 71 (6.9%) participants. Occurrence of a secondary CVD event was more common among sero-positive than among sero-negative patients (adjusted hazard ratio, HR, 1.31, 95% confidence interval (CI) 0.80-2.20), among patients with diabetes HR 2.00 (95% CI 1.20-3.25). The risk of secondary CVD events was strongly increased among patients with both a positive CMV sero-status and diabetes (adjusted HR 2.58, 95% CI 1.32-5.10) compared to CMV negative, non-diabetic patients, whereas either conditions alone was associated with a weak and non-significant increase in risk only.
  
  
  CONCLUSIONS
  Our results are consistent with a possible moderate increase in risk of secondary CVD events among patients with a positive CMV sero-status, and they indicate a strongly increased risk among CMV positive patients with diabetes.
authors.affiliation: Department of Epidemiology, German Centre for Research on Ageing, University of Heidelberg, Bergheimer Str. 20 69115 Heidelberg, Germany. ongey@dzfa.uni-heidelberg.de
authors.forename: Mercy
authors.initials: M
authors.lastname: Guech-Ongey
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.forename: Dorothee
authors.initials: D
authors.lastname: Twardella
authors.forename: Harry
authors.initials: H
authors.lastname: Hahmann
authors.forename: Dietrich
authors.initials: D
authors.lastname: Rothenbacher
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000097:blood* / Q000150:complications*; D048909:Diabetes Complications / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000914:Antibodies, Viral