title: Pathogen burden, cytomegalovirus infection and inflammatory markers in the risk of premature coronary artery disease in individuals of Indian origin.
abstract: BACKGROUND
  Coronary artery disease (CAD) occurs at an earlier age in South Asians compared with other ethnic groups. Infection and inflammation show a positive association with the disease.
  
  
  OBJECTIVE
  To investigate the association of infection and inflammatory markers with premature CAD in the Indian Atherosclerosis Research Study population.
  
  
  METHODS
  Antibody titres for Chlamydia pneumoniae, cytomegalovirus (CMV), Helicobacter pylori, herpes simplex virus and levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), fibrinogen and secretory phospholipase A2, were measured in 866 individuals (433 CAD patients and matched controls). All individuals were followed-up for recurrent cardiac events for four years. ANOVA was used to study the association of infection and inflammation with CAD.
  
  
  RESULTS
  The present study found that the odds of CAD occurrence was 2.42 (95% CI 1.26 to 4.64; P<0.008), with all four infections and increased in the presence of hsCRP (OR 4.67 [95% CI 1.43 to 15.25]); P=0.011). Only anti-CMV antibody levels were a significant risk factor for CAD occurrence (OR 2.23 [95% CI 1.20 to 4.15]; P=0.011) and recurrent cardiac events (OR 1.94 [95% CI 0.85 to 4.45]; P=0.015). Mean values of the inflammatory biomarkers IL-6 (P=0.035), fibrinogen (P=0.014), hsCRP (P=0.010) and secretory phospholipase A2 (P=0.002) increased with CMV antibody levels. Incorporating hsCRP and IL-6 in the risk prediction models significantly increased the OR to 2.56 (95% CI 1.16 to 5.63; P=0.019) with a c statistic of 0.826.
  
  
  CONCLUSIONS
  Pathogen burden, especially CMV infection in combination with inflammatory markers, is a significant predictor of CAD risk in the young Indian population.
authors: Thrombosis Research Institute, Bangalore, India;
authors: Lakshmi A
authors: LA
authors: Mundkur
authors: Veena S
authors: VS
authors: Rao
authors: Sridhar
authors: S
authors: Hebbagudi
authors: Jayashree
authors: J
authors: Shanker
authors: Hemapriya
authors: H
authors: Shivanandan
authors: Radhika K
authors: RK
authors: Nagaraj
authors: Vijay V
authors: VV
authors: Kakkar