title: Infections in early life and premature acute coronary syndrome: A case-control study.
abstract: Infections in young children may affect the vasculature and initiate early atherosclerosis. Whether infections experienced in childhood play a part in adult clinical cardiovascular disease remains unclear. We investigated the association between infections in early life and the occurrence of premature coronary heart disease.
  
  
  
  We conducted a population-based case-control study of 153 patients with a first acute coronary syndrome before the age of 56 years and 153 age- and sex-matched controls. Any history of severe infections in childhood and adolescence was obtained, together with clinical and laboratory measurements and other cardiovascular risk factors. We developed an infection score for the overall burden of early life infections. Conditional logistic regression was used to assess the associations.
  
  
  
  Infections experienced in early life increased the risk of acquiring acute coronary syndrome at a young age with an odds ratio (OR) of 2.67 (95% confidence interval (CI) 1.47-4.83, p = 0.001). After adjustments for traditional risk factors, lifestyle, dietary patterns, socio-economic status and parental history of cardiovascular events, these associations remained significant and changed only slightly. There was an indication for an interaction between infections in early life and current cardiovascular risk (Framingham Risk Score (FRS); p-interaction = 0.052). Within participants with a low FRS (<10%), the OR of early life infection for acute coronary syndrome was 1.49 (95% CI 0.72-3.08, p = 0.283); within participants with an intermediate FRS (10-20%), the OR was 4.35 (95% CI 1.60-11.84, p = 0.004); and within participants with a high FRS (>20%), the OR 10.00 (95% CI 1.21-82.51, p = 0.032).
  
  
  
  Infections in early life may partly explain premature coronary heart disease in adulthood and may potentiate traditional cardiovascular risk factor effects.
authors.affiliation: Department of Cardio-thoracic Surgery, Academic Medical Centre, University of Amsterdam, the Netherlands Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia a.qanitha@amc.uva.nl.
authors.forename: Andriany
authors.initials: A
authors.lastname: Qanitha
authors.affiliation: Department of Cardio-thoracic Surgery, Academic Medical Centre, University of Amsterdam, the Netherlands.
authors.forename: Bastianus Ajm
authors.initials: BA
authors.lastname: de Mol
authors.affiliation: Department of Cardio-thoracic Surgery, Academic Medical Centre, University of Amsterdam, the Netherlands Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia.
authors.forename: Dara R
authors.initials: DR
authors.lastname: Pabittei
authors.affiliation: Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia.
authors.forename: Idar
authors.initials: I
authors.lastname: Mappangara
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands.
authors.forename: Geertje W
authors.initials: GW
authors.lastname: Dalmeijer
authors.affiliation: Department of Paediatrics, University of Melbourne, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Burgner
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands.
authors.forename: Cuno Spm
authors.initials: CS
authors.lastname: Uiterwaal
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007239:Infections / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D011159:Population Surveillance; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Childhood infection; cardiovascular risk factors; premature cardiovascular disease