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High immunoglobulin A seropositivity for combined Chlamydia pneumoniae, Helicobacter pylori infection, and high-sensitivity C-reactive protein in coronary artery disease patients in India can serve as atherosclerotic marker

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Abstract

Atherosclerosis is increasingly recognized as a chronic inflammatory disease. A variety of infectious agents (Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus [CMV]) and inflammatory marker such as high-sensitivity C-reactive protein (hs-CRP) have been found to be associated with atherosclerosis and its consequences. There is a need to know about the type and burden of infection in coronary artery disease (CAD) patients and the level of hs-CRP in India as there is growing evidence that a variety of pathogens are participating in the development and/or acceleration of at least pre-existing atherosclerosis. In addition, there is a need to find the association between these pathogens and conventional risk factors among CAD patients in India, to possibly identify a prognostic marker. In this study 192 patients with incident or prevalent CAD attending the Cardiology Outpatient Department of Safdarjung Hospital, New Delhi, India, were enrolled. In addition, 192 age-and sex-matched controls were also included. Cases and controls differ significantly in seropositivity to C. pneumoniae immunoglobulin IgA (154 vs 76) and IgG (71 vs 48) (P < 0.001, P < 0.015), H. pylori IgA (98 vs 57) and IgG (77 vs 43) (P < 0.001, P < 0.001), CMV IgG (62 vs 38) (P = 0.01) and with hs-CRP (114 vs 60) (P < 0.001), respectively. The level of hs-CRP was higher in CAD patients with IgA seropositivity of C. pneumoniae and H. pylori (5.18 and.65 mg/l) than the IgG of these bacteria (3.73 and 3.36 mg/l), respectively. These findings support an association between specific infectious agents, namely, C. pneumoniae, H. pylori, CMV, and hs-CRP in CAD patients. Association of hs-CRP with IgA specific for C. pneumoniae and H. pylori suggests the role of chronic infection in the development of CAD and may be used as a marker to target the population.

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References

  1. Higgins JP (2003) Chlamydia pneumoniae and coronary artery disease: the antibiotic trials. Mayo Clin Proc 78:321–332

    PubMed  Google Scholar 

  2. Bulliyya G (2000) Key role of dietary fats in coronary heart disease under progressive urbanization and nutritional transition. Asia Pacific J Clin Nutr 9(4):289–297

    Article  Google Scholar 

  3. Deedwania P, Singh V (2005) Coronary artery disease in South Asians: evolving strategies for treatment and prevention. Indian Heart J 57:617–631

    PubMed  Google Scholar 

  4. Jose VJ, Gupta SN (2004) Mortality and morbidity of acute ST segment elevation myocardial infarction in the current era. Indian Heart J 56:210–214

    PubMed  Google Scholar 

  5. Rissa HS, Kishor S, Trehan N (2001) Coronary artery disease in young Indians — the missing link. J Indian Acad Clin Med 2(3): 128–132

    Google Scholar 

  6. Enas AE, Annamalai SK (2001) Coronary artery disease in Asian Indians: an update and review. Internet J Cardiol 1(2)

  7. Vojdani A (2003) A look at infectious agents as a possible causative factor in cardiovascular disease: part I. Lab Med 34(3): 203–212

    Article  Google Scholar 

  8. Fong I W (2000) Emerging relations between infectious diseases and coronary artery disease and atherosclerosis. CMAJ 163(1): 49–56

    PubMed  CAS  Google Scholar 

  9. Cunningham P (2000) Is coronary artery disease an infectious disease? J Inform Pharmacother 2:320–325

    Google Scholar 

  10. Sheehan J, Kearney PM, Sullivan SO, Mongan C, Kelly E, Perry IJ (2005) Acute coronary syndrome and chronic infection in the Cork coronary care case-control study. Heart 91:19–22

    Article  PubMed  CAS  Google Scholar 

  11. Espinola-Klein C, Rupprecht HJ, Blankenberg S, Bickel C, Kopp H, Rippin G, Victor A, Hafner G, Schlumberger W, Meyer J (2002) Impact of infectious burden on extent and long-term prognosis of atherosclerosis. Circulation 105:15–21

    Article  PubMed  Google Scholar 

  12. LaBiche R, Koziol D, Quinn TC, Gaydos C, Azhar S, Ketron G, Sood S, DeGraba TJ (2001) Presence of Chlamydia pneumoniae in human symptomatic and asymptomatic carotid atherosclerotic plaque. Stroke 32:855–860

    PubMed  CAS  Google Scholar 

  13. DeGraba TJ (2004) Immunogenetic susceptibility of atherosclerotic stroke implications on current and future treatment of vascular inflammation. Stroke 35(I):2712–2719

    Article  PubMed  CAS  Google Scholar 

  14. Campbell LA, Kuo CC, Grayston JT (1998) Chlamydia pneumoniae and cardiovascular disease. Emerg Infect Dis 4(4): 571–579

    Article  PubMed  CAS  Google Scholar 

  15. Otsui K, Inoue N, Shiraki SKR, Honjo T, Hirata MTK, Yokoyama SKM (2007) Enhanced expression of TLR4 in smooth muscle cells in human atherosclerotic coronary arteries. Heart Vessels 22:416–422

    Article  PubMed  Google Scholar 

  16. Johnston SC, Messina LM, Browner WS, Lawton MT, Morris C, Dean D (2001) C-reactive protein levels and viable Chlamydia pneumoniae in carotid artery atherosclerosis. Stroke 32:2748–2752

    Article  PubMed  CAS  Google Scholar 

  17. Chen M, Chen C, Wu CYC, Fang C, Chang YHH (2007) Interleukin-18: a strong predictor of the extent of coronary artery disease in patients with unstable angina. Heart Vessels 22:371–375

    Article  PubMed  Google Scholar 

  18. Jha HC, Vardhan H, Gupta R, Varma R, Prasad J, Mittal A (2007) Higher incidence of persistent chronic infection of Chlamydia pneumoniae among coronary artery disease patients in India is a cause of concern. BMC Infect Dis 7:48

    Article  PubMed  Google Scholar 

  19. Prasad A, Zhu J, Halcox JPJ, Waclawiw MA, Epstein SE, Quyyumi AA (2002) Predisposition to atherosclerosis by infections role of endothelial dysfunction. Circulation 106:184–190

    Article  PubMed  Google Scholar 

  20. Hermann C, Graf K, Groh A, Straube E, Hartung T (2002) Comparison of eleven commercial tests for Chlamydia pneumoniae-specific immunoglobulin G in asymptomatic healthy individuals. J Clin Microbiol 40(5):1603–1609

    Article  PubMed  CAS  Google Scholar 

  21. Uter W, Stock C, Pfahlberg A, Guillen-Grima F, Aguinaga-Ontoso I, Brun-Sandiumenge C, Kramer A (2003) Association between infections and signs and symptoms of “atopic” hypersensitivity — results of a cross-sectional survey among first year university students in Germany and Spain. Allergy 58(7):580–584

    Article  PubMed  CAS  Google Scholar 

  22. Miller D, Espinosa-Heidmann D, Legra J, Dubovy S, Suner I, Sedmak D, Dix R, Cousins S (2004) The association of prior cytomegalovirus infection with neovascular age-related macular degeneration. Am J Ophthalmol 138(3):323–328

    Article  PubMed  Google Scholar 

  23. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO, Criqui M, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith SC, Taubert K, Tracy RP, Vinicor F (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107:499–511

    Article  PubMed  Google Scholar 

  24. Kiechl S, Egger G, Mayr M, Wiedermann CJ, Bonora E, Oberhollenzer F, Muggeo M, Xu Q, Wick G, Poewe W, Willeit J (2001) Chronic infections and the risk of carotid atherosclerosis. Circulation.103:1064–10

    PubMed  CAS  Google Scholar 

  25. Ossewaarde JM, Feskens EJM, Vries ADE, Vallinga CE, Kromhout D (1998) Chlamydia pneumoniae is a risk factor for coronary heart disease in symptom-free elderly men, but Helicobacter pylori and cytomegalovirus are not. Epidemiol Infect 120:93–99

    Article  PubMed  CAS  Google Scholar 

  26. Danesh J, Whincup P, Walker M, Lennon L, Thomson A, Appleby P, Wong Y, Bernardes Silva M, Ward M (2000) Chlamydia pneumoniae IgG titers and coronary heart disease: prospective study and meta analysis. BMJ 321:208–213

    Article  PubMed  CAS  Google Scholar 

  27. LaBiche R, Koziol D, Quinn TC, Gaydos C, Azhar S, Ketron G, Sood S, DeGraba TJ (2001) Presence of Chlamydia pneumoniae in human symptomatic and asymptomatic carotid atherosclerotic plaque. Stroke 32:855–860

    PubMed  CAS  Google Scholar 

  28. Schumacher A, Lerkerod AB, Seljeflot I, Sommervoll L, Holme I, Otterstad JE, Arnesen H (2001) Chlamydia pneumoniae serology: importance of methodology in patients with coronary heart disease and healthy individuals. J Clin Microbiol 39:1859–1864

    Article  PubMed  CAS  Google Scholar 

  29. Persson K, Boman J (2000) Comparison of five serologic tests for diagnosis of acute infections by Chlamydia pneumoniae. Clin Diagn Lab Immunol 7:739–744

    Article  PubMed  CAS  Google Scholar 

  30. Adiloglu AK, Can R, Nazli C, Ocal A, Ergene O, Tinaz G, Kisioglu N (2005) Ectasia and severe atherosclerosis. Tex Heart Inst J 32:21–27

    PubMed  Google Scholar 

  31. Yamaoka-Tojo M, Tojo T, Machida TMY, Kitano Y, Izumi TKT (2003) C-reactive protein-induced production of interleukin-18 in human endothelial cells: a mechanism of orchestrating cytokine cascade in acute coronary syndrome. Heart Vessels 18:183–187

    Article  PubMed  Google Scholar 

  32. Arroyo-Espliguero R, Avanzas P, Cossın-Sales J, Aldama G, Pizzi C, Kaski JC (2004) C-reactive protein elevation and disease activity in patients with coronary artery disease. Eur Heart J 25:401–408

    Article  PubMed  CAS  Google Scholar 

  33. Haidari M, Javadib E, Sadeghia B, Hajilooia M, Ghanbili J (2001) Evaluation of C-reactive protein, a sensitive marker of inflammation, as a risk factor for stable coronary artery disease. Clin Biochem 34(4):309–315

    Article  PubMed  CAS  Google Scholar 

  34. Huittinen T, Leinonen M, Tenkanen L, Virkkunen H, Mänttäri M, Palosuo T, Manninen V, Saikku P (2003) Synergistic effect of persistent Chlamydia pneumoniae infection, autoimmunity, and inflammation on coronary risk. Circulation 107:2566–2570

    Article  PubMed  Google Scholar 

  35. Kiechl S, Werner P, Egger G, Oberhollenzer F, Mayr M, Xu Q, Poewe W, Willeit J (2002) Active and passive smoking, chronic infections, and the risk of carotid atherosclerosis. Stroke 33: 2170–2176

    Article  PubMed  Google Scholar 

  36. Kiechl S, Willeit J, Rungger G, Egger G, Oberhollenzer F, Bonora E (1998) Alcohol consumption and atherosclerosis: what is the relation? Stroke 29:900–927

    PubMed  CAS  Google Scholar 

  37. Solomon CG, Hu FB, Stampfer MJ, Colditz GA, Speizer FE, Rimm EB, Willett WC, Manson JE (2000) Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus. Circulation 102:494–499

    PubMed  CAS  Google Scholar 

  38. Ghiselli G, Chen J, Kaou M, Hallak H, Rubin R (2003) Ethanol inhibits fibroblast growth factor-induced proliferation of aortic smooth muscle cells. Arterioscler Thromb Vasc Biol 23:1808–1813

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Hem Chandra Jha.

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Jha, H.C., Prasad, J. & Mittal, A. High immunoglobulin A seropositivity for combined Chlamydia pneumoniae, Helicobacter pylori infection, and high-sensitivity C-reactive protein in coronary artery disease patients in India can serve as atherosclerotic marker. Heart Vessels 23, 390–396 (2008). https://doi.org/10.1007/s00380-008-1062-9

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  • DOI: https://doi.org/10.1007/s00380-008-1062-9

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