July 3, 2001Circulation255 citations
Impact of Viral and Bacterial Infectious Burden on Long-Term Prognosis in Patients With Coronary Artery Disease
View Full Paper
Key Result
A higher infectious burden (>5 vs <4 pathogens) was associated with a significantly increased risk of future cardiac death in patients with CAD (HR 5.1; 95% CI 1.4-18.3; P<0.0001).
Key Points
- This study aims to explore the correlation between infectious burden and long-term cardiac prognosis in coronary artery disease (CAD) patients.
- Evaluated 1018 patients with angiographically documented CAD for IgG/IgA antibodies against 8 pathogens.
- Measured highly sensitive C-reactive protein levels and followed up for cardiovascular events over 3.1 years on average.
- Categorized patients based on the number of positive serologies and analyzed mortality outcomes.
- Patients with seropositive responses to Epstein-Barr virus (P=0.001), H. pylori (P=0.002), and herpes simplex virus type 2 (P=0.045) had a higher future risk of cardiovascular death.
- Increasing pathogen burden (0-3, 4-5, and 6-8 seropositive pathogens) was linked to mortality rates of 3.7%, 7.2%, and 12.6%, respectively.
- Those seropositive to more than 5 pathogens had a 5.1 higher risk of future cardiac death compared to those with fewer than 4 pathogens (1.4 to 18.3), mainly influenced by Herpesviridae.
Study Design
Type
Cohort (n=1,018)
Structured PICO
Does a higher infectious burden increase the risk of cardiovascular death in patients with documented CAD?
P
Population
1018 patients with angiographically documented coronary artery disease (CAD)
I
Intervention
High infectious burden (seropositive to >5 of 8 tested pathogens)
C
Comparator
Low infectious burden (seropositive to <4 pathogens)
O
Outcome
Future fatal cardiac events (cardiovascular death)hard clinical
A higher aggregate burden of prior viral and bacterial infections is independently associated with an increased risk of long-term cardiovascular mortality in patients with coronary artery disease.
Main Result
Effect estimate: HR 5.1 (95% CI 1.4-18.3)
Absolute Event Rate: 12.6% vs 3.7%
p-value: p=<0.0001
Abstract
BACKGROUND: The number of infectious pathogens to which an individual has been exposed (infectious burden) may correlate with coronary artery disease (CAD). In a prospective study, we evaluated the effect of 8 pathogens and the aggregate pathogen burden on the risk for future fatal cardiac events among patients with angiographically documented CAD. Methods and Results-In 1018 patients, IgG or IgA antibodies to herpes simplex virus types 1 and 2, cytomegalovirus, Epstein-Barr virus, Haemophilus influenzae, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Helicobacter pylori were determined. Moreover, highly sensitive C-reactive protein was measured. Follow-up information on cardiovascular events was obtained (mean 3.1 years, maximum 4.3 years). Seropositivities to Epstein-Barr virus (P=0.001), H pylori (P=0.002), and herpes simplex virus type 2 (P=0.045) were independently associated with the future risk of cardiovascular death. An increasing number for pathogen burden was significantly predictive of the long-term prognosis (P5 pathogens compared with those seropositive to <4 pathogens had a 5.1 (1.4 to 18.3) higher risk of future cardiac death. This result was mainly driven by the pathogen burden of seropositivities to Herpesviridae (P<0.0001). The prognostic impact of total or viral pathogen burden was independent of the C-reactive protein level. CONCLUSIONS: These results support the hypothesis that the number of infectious pathogens to which an individual has been exposed independently contributes to the long-term prognosis in patients with documented CAD.
Cite This Study
Rupprecht et al. (2001) conducted a cohort in Coronary Artery Disease (n=1,018). High infectious burden (>5 pathogens) vs. Low infectious burden (<4 pathogens) was evaluated on Future fatal cardiac events (cardiovascular death) (HR 5.1, 95% CI 1.4-18.3, p=<0.0001). A higher infectious burden (>5 vs <4 pathogens) was associated with a significantly increased risk of future cardiac death in patients with CAD (HR 5.1; 95% CI 1.4-18.3; P<0.0001).