title: Dual role of infections as risk factors for coronary heart disease.
abstract: OBJECTIVE
  The aim of the study was to explore whether exposure to microbial agents determines the prevalence of acute coronary events.
  
  
  RESULTS
  Patients with unstable angina pectoris and myocardial infarction (N=335) and their paired controls were investigated. The subjects answered a questionnaire about their childhood contagious diseases: varicella, scarlet fever, measles, rubella, mononucleosis and mumps. Blood samples were taken for bacterial and viral serology. The odds ratio for CHD was highest in the upper quartile of the enterovirus (EV), herpes simplex virus (HSV) and Chlamydia pneumoniae HSP60 IgG antibody titers (1.86, p=0.001, 1.57, p<0.048 and 1.70, p=0.016, respectively). The antibody titers increased cumulatively the risk for CHD (odds ratios 1.89, 2.24, 3.92 and p-values <0.001, 0.001 and 0.047). Childhood contagious diseases (n=6) had a protecting effect against CHD (odds ratio 0.86, p=0.013). The risk for acute coronary events decreased significantly with increasing number of childhood contagious diseases (p=0.007).
  
  
  CONCLUSIONS
  Infections have a dual role in the genesis of CHD. EV, HSV and C. pneumoniae heat shock protein 60 IgG antibodies are associated with increased risk for CHD. Protection from infections usually suffered during the childhood before the era of MMR vaccination may predispose the individual to CHD.
authors.affiliation: Pediatric Cardiology, University Hospital of Lund, Lund, Sweden. erkki.pesonen@skane.se <erkki.pesonen@skane.se>
authors.forename: Erkki
authors.initials: E
authors.lastname: Pesonen
authors.forename: Eva
authors.initials: E
authors.lastname: Andsberg
authors.forename: Hans
authors.initials: H
authors.lastname: Ohlin
authors.forename: Mirja
authors.initials: M
authors.lastname: Puolakkainen
authors.forename: Hilpi
authors.initials: H
authors.lastname: Rautelin
authors.forename: Seppo
authors.initials: S
authors.lastname: Sarna
authors.forename: Kenneth
authors.initials: K
authors.lastname: Persson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology; D000907:Antibodies, Bacterial / Q000032:analysis; D000914:Antibodies, Viral / Q000032:analysis; D018834:Chaperonin 60 / Q000276:immunology; D002644:Chickenpox / Q000150:complications; D002648:Child; D016993:Chlamydophila pneumoniae / Q000276:immunology; D003327:Coronary Disease / Q000209:etiology*; D004770:Enterovirus / Q000276:immunology; D005260:Female; D006801:Humans; D007107:Immune System / Q000254:growth & development; D007239:Infections / Q000150:complications*; D007244:Infectious Mononucleosis / Q000150:complications; D008297:Male; D008457:Measles / Q000150:complications; D008875:Middle Aged; D009107:Mumps / Q000150:complications; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D012307:Risk Factors; D012409:Rubella / Q000150:complications; D012541:Scarlet Fever / Q000150:complications; D018139:Simplexvirus / Q000276:immunology
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D018834:Chaperonin 60