Key result
Concurrent elevated CRP and H. pylori seropositivity linked to ~98% greater odds of ECG-defined CAD.
Why the study?
Elevated CRP and chronic infections have been implicated in CAD pathogenesis, but their combined association with ECG-defined CAD in the general population is unclear.
Is concurrent elevated CRP and chronic infection associated with electrocardiogram-defined CAD in a general population?
Cross-Sectional (n=1,754)
Yes
Is concurrent elevated CRP and chronic infection associated with electrocardiogram-defined CAD in a general population?
Odds Ratio: 1.98 (95% CI 1.26–3.13)
p-value: p=0.003
Concurrent chronic infection and elevated CRP are significantly associated with electrocardiogram-defined CAD, suggesting a synergistic role in atherosclerosis beyond traditional risk factors.
May support infection-inflammation synergy in CAD; leaves open causality and need for prospective validation.
BACKGROUND: An elevated serum level of C-reactive protein (CRP) is an independent predictor of coronary artery disease (CAD). Chronic infections have also been implicated in the pathogenesis of CAD. AIMS: To investigate how concomitant chronic infection and CRP related to electrocardiogram-defined CAD in a general population. SETTING AND DESIGN: A population-based cross-sectional study, which was conducted in three Iranian ports in the northern Persian Gulf. MATERIALS AND METHODS: For evaluation of CAD, we used Minnesota coding criteria of a 12-lead resting electrocardiogram in 1,754 subjects, aged 25 years and over, selected by cluster random sampling. Sera were analyzed for IgG antibodies to Chlamydia pneumoniae (C. pneumoniae), Herpes simplex virus type 1 (HSV-1), Helicobacter pylori (H. pylori) and cytomegalovirus (CMV) using ELISA. Measurement of CRP by a high-sensitivity CRP assay was done. STATISTICAL ANALYSIS: Multiple logistic regression analysis was used. RESULTS: None of the infectious agents (CMV, H. pylori, C. pneumoniae and HSV-1) showed a significant association with electrocardiogram-defined CAD after adjusting for sex and age. Elevated CRP levels did not show significant association with electrocardiogram-defined CAD independent of seropositivity to one of the four infectious agents, but concurrent elevated CRP levels (>10.0 mg/L) and anti-C. pneumoniae [OR = 1.68 (CI, 1.24-2.59; P=0.04)], H. pylori [OR = 1.98 (CI, 1.26-3.13; P=0.003)], CMV [OR = 1.66 (CI, 1.10-2.49; P=0.01)] or HSV-1 [OR=1.79 (CI, 1.18-2.72; P=0.006)] IgG antibodies were associated with prevalence of electrocardiogram-defined CAD in the general population, after adjustment for multiple risk factors, including age, sex and the components of the metabolic syndrome. CONCLUSIONS: Beyond traditional cardiovascular risk factors, concomitant chronic infection and elevated CRP are significantly correlated with electrocardiogram-defined CAD.
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Nabipour et al. (2007) conducted a cross-sectional in coronary artery disease (n=1,754). Concurrent elevated CRP (>10.0 mg/L) and chronic infection seropositivity vs. Absence of concurrent elevated CRP and chronic infection was evaluated on electrocardiogram-defined CAD (OR 1.98, 95% CI 1.26-3.13, p=0.003). Concurrent elevated CRP (>10 mg/L) and seropositivity for H. pylori (OR 1.98, 95% CI 1.26-3.13), C. pneumoniae, CMV, or HSV-1 were significantly associated with electrocardiogram-defined CAD.
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