The prospective association of Chlamydia pneumoniae and four other pathogens with development of coronary artery calcium: the multi-ethnic study of atherosclerosis (MESA).
OBJECTIVE
Previous basic and cross-sectional studies obtained conflicting results regarding the association of pathogens with coronary artery calcium (CAC). The aim of this study is to prospectively evaluate this association in a population-based cohort.


METHODS
We examined 5744 individuals aged 45-84 years at baseline (2000-02) who underwent repeated CAC assessment on average 2.4 years later (a half at visit 2 [2002-04] and the other half at visit 3 [2004-05]). CAC incidence was defined as newly detectable CAC at follow-up (475 cases of 2942 participants). CAC progression was defined as annualized change in CAC Agatston score ≥10 units/year if baseline CAC score >0 to <100 or ≥10%/year if baseline score ≥ 100 (1537 cases of 2802 participants). Seropositivity was assessed in the entire cohort for Chlamydia pneumoniae and in a random sample (n = 873) for Helicobacter pylori, cytomegalovirus, herpes simplex virus, and hepatitis A virus.


RESULTS
Seropositivity to C. pneumoniae was not significantly associated with CAC incidence (odds ratio [OR] 1.11 [95% CI, 0.88-1.39], P = 0.371) or progression (1.14 [0.96-1.36], P = 0.135) even in unadjusted models. When CAC incidence and progression were combined, we observed significant association with C. pneumoniae seropositivity before adjustment (OR 1.17 [1.03-1.33], P = 0.016) but not in a model adjusting for traditional risk factors (1.04 [0.90-1.19], P = 0.611). The results were consistent across subgroups according to age, sex, and race/ethnicity. None of five pathogens or their accrual was associated with CAC incidence and progression in the subsample.


CONCLUSIONS
Our prospective study does not support the pathophysiological involvement of these pathogens in CAC development.
Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA; Netherlands Institute for Health Sciences, Erasmus University, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. Electronic address: babraylaek@gmail.com.
Babray
B
Laek
Moyses
M
Szklo
Robyn L
RL
McClelland
Jingzhong
J
Ding
Michael Y
MY
Tsai
David A
DA
Bluemke
Russell
R
Tracy
Kunihiro
K
Matsushita
D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000208:ethnology / Q000382:microbiology / Q000473:pathology* / Q000821:virology; D002114:Calcinosis / Q000382:microbiology / Q000473:pathology* / Q000821:virology; D002118:Calcium / Q000378:metabolism; D016993:Chlamydophila pneumoniae; D003331:Coronary Vessels / Q000382:microbiology / Q000473:pathology*; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications; D018450:Disease Progression; D005260:Female; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006506:Hepatitis A / Q000150:complications; D030041:Hepatitis A virus; D006561:Herpes Simplex / Q000150:complications; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D018139:Simplexvirus
D002118:Calcium
Atherosclerosis; Coronary calcium; Infection; Pathogens