Human cytomegalovirus neutralising antibodies and increased risk of coronary artery disease in Indian population.
BACKGROUND
Several studies have reported a conflicting association between cytomegalovirus (CMV) infection and coronary artery disease (CAD) based on the levels of total anti-CMV antibodies. However, none have estimated the levels of specific neutralising antibodies (NA) to CMV, which may be clinically more relevant.


OBJECTIVE
To determine whether CMV-NA titres show a better association with CAD compared with total anti-CMV antibody levels.


METHODS
CMV-NA titres were measured by micro-neutralisation assay and anti-CMV IgG antibodies using ELISA in 391 consecutive CAD patients compared with the same number of controls (N=782), and 91 patients reporting recurrent cardiac events during a 4-year follow-up compared with those without a recurrent event (N=182). Levels of inflammatory markers, interleukin 6, high-sensitivity C reactive protein, fibrinogen and secretory phospholipase A2 (sPLA2), were measured by ELISA. Analysis of variance and logistic regression were used for statistical analyses.


RESULTS
High CMV-NA titres showed a positive association with CAD occurrence (OR 2.24, 95% CI 1.31 to 3.85, p=0.003) and recurrent cardiac events in CAD patients (OR 4.65, 95% CI 1.21 to 17.86, p=0.025) compared with total CMV antibodies (OR 1.67, 95% CI 1.04 to 2.69, p=0.034, and 2.70, 1.04 to 7.02, p=0.040, respectively). Patients with higher quartile of CMV-NA titres and sPLA2 levels had an adjusted OR of 7.82 (95% CI 1.87 to 32.65, 0.005) for recurrent cardiac events compared with those with the lowest quartiles for both markers.


CONCLUSIONS
These findings suggest that high CMV-NA titres in combination with inflammatory markers improve prediction of cardiac events in the Asian Indian population.
Thrombosis Research Institute, Narayana Hrudayalaya, Anekal Taluk, Bangalore, India.
Lakshmi Ashutosh
LA
Mundkur
Hemapriys
H
Shivanandan
Sridhara
S
Hebbagudi
Valeria
V
Endrész
Meenakshi
M
Varma
Veena
V
Rao
Eva
E
Gonczol
Vijay Vir
VV
Kakkar
D057134:Antibodies, Neutralizing / Q000276:immunology*; D000914:Antibodies, Viral / Q000276:immunology*; D015415:Biomarkers; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000276:immunology*; D003587:Cytomegalovirus / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral; D015415:Biomarkers