title: Elevated infection parameters and infection symptoms predict an acute coronary event.
abstract: 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).
authors.affiliation: Department of Pediatric Cardiology, University Hospital, Lund, Sweden. erkki.pesonen@med.lu.se
authors.forename: Erkki
authors.initials: E
authors.lastname: Pesonen
authors.forename: Eva
authors.initials: E
authors.lastname: Andsberg
authors.forename: Anders
authors.initials: A
authors.lastname: Grubb
authors.forename: Hilpi
authors.initials: H
authors.lastname: Rautelin
authors.forename: Seppo
authors.initials: S
authors.lastname: Meri
authors.forename: Kenneth
authors.initials: K
authors.lastname: Persson
authors.forename: Mirja
authors.initials: M
authors.lastname: Puolakkainen
authors.forename: Seppo
authors.initials: S
authors.lastname: Sarna
authors.forename: Hans
authors.initials: H
authors.lastname: Ohlin
mesh_terms: 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