Gender, chronic infection and myocardial infarction

D ear S ir, Reuterwall et al., in their wide and exhausting study on gender and risk of myocardial infarction, found higher relative risk in men than in women, but an inverse pattern in absolute risk [1]. Their thorough evaluation of major risk factors overviews different aspects, including lifestyles and blood lipid profiles. Myocardial infarction, however, as well as other syndromes of unstable ischaemic heart disease, has been related by many authors to novel risk factors and various serologic values have been indicated as markers of instability and prognostic factors of coronary artery disease indicating a poor outcome after the occurrence of an acute event. Elevated levels at discharge of C-reactive protein, fibrinogen, serum amyloid protein, troponin T and positive serology for Chlamydia pnuemoniaeor Helicobacter pylori infection are amongst these. All of these variables were found to be present more frequently in male than in female patients [2]. In particular, when adjusting data for socioeconomic status, the presence of an inflammatory status in which a chronic, persistent infection could represent the cause, should have been evaluated. Inclusion of these factors could bring further clues (or raise new questions) to the issue of the differences in risk of myocardial infarction with respect to gender. Received 22 September 1999; accepted 6 October 1999.