title: Association Between Toxoplasma gondii Exposure and Heart Disease: A Case-Control Study.
abstract: BACKGROUND
  The parasite Toxoplasma gondii causes infections all around the world. Infections with T. gondii are systemic and the parasite can persist in the heart muscle. Very little is known about the impact of T. gondii on patients with heart disease. We determined the association between T. gondii exposure and patients suffering from heart diseases attending in a public hospital in Durango, Mexico; the association of T. gondii exposure with socio-demographic, behavioral, and clinical characteristics of these patients was also investigated.
  
  
  METHODS
  Through a case-control study, we examined the seroprevalence of anti-T. gondii IgG and IgM antibodies in 400 patients with heart diseases and 400 age- and gender-matched controls using enzyme-linked immunoassays. In addition, we analyzed the association of patient characteristics as determined by a standardized questionnaire with T. gondii exposure by bivariate and multivariate analyses.
  
  
  RESULTS
  Fifty-five (13.8%) of 400 patients and 32 (8.0%) of 400 controls had anti-T. gondii IgG antibodies (odds ratio (OR) = 1.83; 95% confidence interval (CI): 1.15 - 2.90; P = 0.01). High anti-T. gondii IgG levels (> 150 IU/mL) were found in 28 (50.9%) of the 55 positive cases and in 14 (43.8%) of the 32 positive controls (P = 0.51). Anti-T. gondii IgM antibodies were found in 13 (23.6%) of the 55 anti-T. gondii IgG positive patients and in 19 (59.4%) of 32 anti-T. gondii IgG positive controls (OR = 0.21; 95% CI: 0.08 - 0.54; P = 0.0008). Multivariate analysis showed that T. gondii exposure was positively associated with being born out of Durango State (OR = 2.93; 95% CI: 1.40 - 6.13; P = 0.004), and with consumption of alcohol (OR = 2.04; 95% CI: 1.01 - 4.12; P = 0.04).
  
  
  CONCLUSIONS
  Results obtained in this study indicate that T. gondii infection is associated with heart disease, and suggest that heart disease might be related with a chronic infection. This is the first report of an association of T. gondii exposure with alcohol consumption in this population. Results warrant for further research to determine the epidemiological impact of T. gondii exposure on patients with heart diseases. Risk factors associated with T. gondii exposure are critical to design future prevention strategies against T. gondii exposure.
authors.affiliation: Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico.
authors.forename: Cosme
authors.initials: C
authors.lastname: Alvarado-Esquivel
authors.affiliation: Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico.
authors.forename: Misael
authors.initials: M
authors.lastname: Salcedo-Jaquez
authors.affiliation: Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico.
authors.forename: Luis Francisco
authors.initials: LF
authors.lastname: Sanchez-Anguiano
authors.affiliation: Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico.
authors.forename: Jesus
authors.initials: J
authors.lastname: Hernandez-Tinoco
authors.affiliation: Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico; Hospital General, Servicios de Salud de Durango, Cuauhtemoc 225 norte. 34000 Durango, Mexico.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rabago-Sanchez
authors.affiliation: Facultad de Enfermeria y Obstetricia, Juarez University of Durango State, Cuauhtemoc 223 norte, 34000 Durango, Mexico.
authors.forename: Isabel
authors.initials: I
authors.lastname: Beristain-Garcia
authors.affiliation: Institute for Microbiology and Hygiene, Campus Benjamin Franklin, Charite Medical School, Hindenburgdamm 27, D-12203 Berlin, Germany; Present address: Roche Molecular Diagnostics, Pleasanton, CA, USA.
authors.forename: Oliver
authors.initials: O
authors.lastname: Liesenfeld
authors.affiliation: Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico.
authors.forename: Sergio
authors.initials: S
authors.lastname: Estrada-Martinez
authors.affiliation: Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico.
authors.forename: Alma Rosa
authors.initials: AR
authors.lastname: Perez-Alamos
authors.affiliation: Facultad de Enfermeria y Obstetricia, Juarez University of Durango State, Cuauhtemoc 223 norte, 34000 Durango, Mexico.
authors.forename: Ediyair
authors.initials: E
authors.lastname: Alvarado-Soto
keywords: Alcohol; Case-control study; Epidemiology; Heart disease; Seroprevalence; Toxoplasma gondii