Elevated infection parameters and infection symptoms predict an acute coronary event.
BACKGROUND
The etiology and significance of flu-like symptoms often appearing before myocardial infarction should be clarified.


METHODS
In a case-control study of 323 matched controls and a random sample of 110 out of 351 cases the presence of infection symptoms during the preceding four weeks before admission were asked and blood samples taken.


RESULTS
Enterovirus (EV), herpes simplex virus (HSV), and Chlamydia pneumoniae IgA titers were significantly higher in cases than in controls (p<0.001, 0.008 and 0.046, respectively). Flu-like symptoms appeared significantly more often in patients than in controls the most common one being fatigue (p<0.001). In controls with fatigue, EV and HSV titers showed a trend to be higher (1.50 vs 1.45 and 4.29 vs 3.73) than in controls without fatigue but only HSV titers were statistically significantly higher (3.47 vs 3.96, p = 0.02). Even CRP and amyloid A concentrations (3.49 vs 2.08, p<0.0001 and 5.70 vs 3.77 mg/l, p = 0.003, respectively) as well as C4 (0.40 vs 0.44, p = 0.02) were higher in controls with fatigue.


CONCLUSIONS
Odds ratios for a coronary event in a logistic regression model were 4.79 for fatigue and 2.72 for EV antibody levels in their fourth quartile. A linear-by-linear association test showed increasing number of single symptoms with higher EV titer quartiles (p = 0.004).
Pesonen
Erkki
E
Department of Pediatric Cardiology, University Hospital, Lund, Sweden. erkki.pesonen@med.lu.se
Andsberg
Eva
E
Grubb
Anders
A
Rautelin
Hilpi
H
Meri
Seppo
S
Persson
Kenneth
K
Puolakkainen
Mirja
M
Sarna
Seppo
S
Ohlin
Hans
H
D000208:Acute Disease; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000453:epidemiology*; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D007249:Inflammation / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors