Individual pathogens, pathogen burden and markers of subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis.
METHODS
We examined the cross-sectional relationships of subclinical atherosclerosis - expressed by carotid intimal-medial thickness and coronary calcification - with antibodies to Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, herpes simplex virus, hepatitis A virus, and pathogen burden (number of positive pathogens). A random sample of 1056 individuals chosen from 5030 Multi-Ethnic Study of Atherosclerosis cohort participants were included.


RESULTS
After multiple adjustment, no associations were found between atherosclerosis measures and either individual pathogens or pathogen burden. Interactions with inflammatory and endothelial function markers, demographic factors, BMI, high-density lipoprotein, diabetes, and smoking were also explored. The only interaction that was large, qualitative, statistically significant (P < 0.05) and in the expected direction was that between hepatitis A virus and soluble intercellular adhesion molecule-1 with regard to Agatston calcium score: the difference between hepatitis A virus-positive and hepatitis A virus-negative participants was -186 units in participants with soluble intercellular adhesion molecule-1 below the median, and +162 units in those with soluble intercellular adhesion molecule-1 equal or above the median. However, given the number of interactions that were explored, these results must be interpreted cautiously.


CONCLUSIONS
Findings from the present analyses do not provide support for an infectious etiology for subclinical atherosclerosis. However, the study's limitations, which include its cross-sectional design and insufficient statistical power, suggest that inferences from its findings should be made cautiously.
Szklo
Moyses
M
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. mszklo@jhsph.edu
Ding
Jingzhong
J
Tsai
Michael Y
MY
Cushman
Mary
M
Polak
Joseph F
JF
Lima
João
J
Barr
R Graham
RG
Sharrett
A Richey
AR
D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D050197:Atherosclerosis / Q000453:epidemiology* / Q000382:microbiology; D002118:Calcium / Q000032:analysis; D002339:Carotid Arteries / Q000737:chemistry; D023521:Chlamydophila Infections / Q000453:epidemiology*; D016993:Chlamydophila pneumoniae / Q000302:isolation & purification; D003331:Coronary Vessels / Q000737:chemistry; D003430:Cross-Sectional Studies; D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D004730:Endothelium, Vascular / Q000503:physiopathology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006561:Herpes Simplex / Q000453:epidemiology*; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D016036:Seroepidemiologic Studies; D014481:United States / Q000453:epidemiology; D019562:Viral Load
D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D002118:Calcium