Evaluation of C-reactive protein, an inflammatory marker, and infectious serology as risk factors for coronary artery disease and myocardial infarction

Gamma-glutamyl transpeptidase and indirect bilirubin may participate in systemic inflammation of patients with psoriatic arthritis

BACKGROUND

Previous studies have suggested that systemic metabolic abnormalities are closely related to psoriatic arthritis (PsA). Gamma-glutamyl transpeptidase (GGT) and indirect bilirubin (IBIL), two essential active substances in hepatic metabolism that have been demonstrated as an oxidative and anti-oxidative factor respectively, have been proved to be involved in oxidative stress damage and inflammation in several human diseases. However, their role in PsA remains unclear.

METHODS

In this retrospective comparative cohort study, a case group of 68 PsA patients and a control group of 73 healthy volunteers from the Third Hospital of Hebei Medical University were enrolled. Serum GGT, IBIL, GGT/IBIL ratio and C-reactive protein (CRP), a well applied bio-marker of systemic inflammatory in PsA, were compared between the two groups. Furthermore, the relationship of GGT, IBIL and GGT/IBIL with CRP were explored in PsA patients. Finally, the patients were divided into high inflammation group and low inflammation group according to the median value of CRP. Multivariate logistic regression analyses were used for the association of systemic inflammation level with GGT, IBIL and GGT/IBIL.

RESULTS

Compared with healthy controls, PsA patients exhibited significantly higher serum GGT, GGT/IBIL, and CRP levels and lower IBIL levels. Serum GGT and GGT/IBIL were positively correlated with CRP, whereas IBIL were negatively correlated with CRP. Binary logistic regression analysis revealed that serum GGT was a risk factor for high CRP in PsA, whereas IBIL was a protective factor. Furthermore, GGT/IBIL was a better indicator of high CRP condition in PsA patients than either GGT or IBIL alone, as determined by the receiver operating characteristic curves.

CONCLUSION

GGT and IBIL may participate in the pathogenesis of PsA. Additionally, GGT, IBIL and the balance of the two may reflect systemic inflammation mediated by oxidative stress events related to metabolic abnormalities to a certain extent.

Chlamydia pneumoniae and Mycoplasma pneumoniae as two Emerging Risk Factors in Atherosclerosis: Meta-Analysis Study and Systematic Review

BACKGROUND

Previous studies suggested an association between Chlamydia pneumoniae and Mycoplasma pneumonia with atherosclerosis, separately. Until now, according to inconsistent information, the relationship between C.pneumoniae and M.pneumoniae with atherosclerosis is controversial.

OBJECTIVE

the aim of this study, investigate of the association between C.pneumoniae and M.pneumoniae as two separate risk factors with atherosclerosis by systematic review and meta-analysis study.

METHODS

We searched databases such as Pubmed, SID, Magiran, Google scholar and Iranmedex using the following keywords in English and Persian language as C. pneumoniae , M. pneumoniae and atherosclerosis. Data were analyzed with meta-analysis and a random effect model. Also, in this study Heterogeneity of articles were estimated by using I2 index. Finally, data was analyzed with STAT (version 11.2) Results: Among thirty-eight articles for C. pneumoniae and five articles for M. pneumoniae individually reviewed that included 2980 samples for M. pneumoniae and 23298 samples for C. pneumoniae, result demonstrated that association between M. pneumoniae and C. pneumoniae with atherosclerosis is significant with OR (odd ratio) = 1.58 (95% Confidence Interval (CI): 1.00 to 2.50), OR (odd ratio) = 2.25(95% Confidence Interval (CI): 1.91 to 2.64), respectively.

CONCLUSION

This systematic review study provides strong evidence for the role of persistent bacterial infection such as M. pneumoniae and C. pneumoniae in potential atherosclerosis. Thus, a novel way should be employed for the complete management of bacterial infection.

The global prevalence of Chlamydia pneumoniae, Helicobacter pylori, Cytomegalovirus and Herpes simplex virus in patients with coronary artery disease: A systematic review and meta-analysis

BACKGROUND AND AIM

Coronary Artery Disease (CAD) is one of the most important causes of death worldwide. The aim of this study was to determine the prevalence of C. pneumoniae, H. pylori, Cytomegalovirus (CMV) and Herpes simplex virus (HSV) in CAD patients based on published serological and molecular studies.

METHODS

A systematic literature search was conducted in Medline (via PubMed), Embase, Scopus and Web of Science databases (1996-2019). Both molecular and serological studies were analyzed using STATA software (Version 14).

RESULTS

145 studies were included for final analysis. We gathered and investigated the prevalence of C. pneumoniae (25.1% [95% confidence interval (CI) 21.5-28.8%]), H. pylori (12.8% [(95% CI) 4.0-22.0%]), CMV (64.4% [(95% CI) 57.7-73.0%]) and HSV (31.8% [(95% CI) 21.5-42.2%]) in CAD patients from the analysis of molecular studies. Additionally, in serological studies, the prevalence of mentioned pathogens were 72.7% [(95% CI) 67.8-77.6%], 63.3% [(95% CI) 60.0-66.5%], 62.2% [(95% CI) 58.0-66.3%] and 34.3% [(95% CI) 23.6-45.1%] respectively.

CONCLUSION

Interestingly, there was only a significant increase in the prevalence of C. pneumoniae and H. pylori in serological studies compared to the reported data from molecular studies, while the prevalence of CMV and HSV were the same in both types of studies.

Relation Between Globulin, Fibrinogen, and Albumin With the Presence and Severity of Coronary Artery Disease

The albumin to globulin ratio (AGR) is used as a prognostic marker in acute ischemic cardiovascular events. We investigated whether serum AGR, fibrinogen, and fibrinogen to albumin ratio (FAR) are related to the presence and severity of coronary artery disease (CAD). Patients who underwent coronary angiography procedures were analyzed retrospectively. The severity of CAD was assessed by the Gensini score. The study population (3031 patients; 1071 females and 1960 males) was divided into 3 tertiles based on AGR values. Gensini score, lipid levels, diabetes mellitus (DM), hypertension (HT), age, and fibrinogen level were higher in the low AGR group. Pearson correlation analysis showed that AGR (r = -0.068, P < .001) was negatively and fibrinogen (r = 0.187, P < .001) was positively correlated with the Gensini score. Male gender, HT, smoking, DM, age, high triglyceride (TG) level, low-density lipoprotein cholesterol (LDL-C) >160 mg/dL, estimated glomerular filtration rate (eGFR) <60 mL/min, and fibrinogen level >3.5 g/L were independent predictors of CAD. Male gender, age, eGFR, DM, LDL-C, TG, and FAR had an independent positive relation to the Gensini score. In conclusion, similar to traditional risk factors, plasma fibrinogen and albumin levels showed a close relation with the presence and severity of CAD.

Detection of ADTRP in circulation and its role as a novel biomarker for coronary artery disease

Androgen dependent tissue factor pathway inhibitor regulating protein (ADTRP) is a novel protein associated with coronary artery disease (CAD) susceptibility, and reduced mRNA expression of ADTRP was shown to be associated with increased CAD risk. This study aimed to determine and compare circulating ADTRP levels between CAD patients and controls, and to test the performance of plasma ADTRP as a biomarker for CAD. We measured plasma ADTRP, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and high sensitivity-C reactive protein (hs-CRP) levels in 362 CAD patients, 150 angiographically negative CAD controls, and 83 healthy adults with no known clinical or medical conditions using commercial ELISA. Statistical analyses were performed using receiver operator characteristic (ROC) curves, quantile regression and logistic regression, with adjustments for age, gender, ethnicity and BMI. CAD patients had significantly lower plasma ADTRP levels 1,545 (1,087–2,408) pg/ml as compared to CAD controls 2,259 (1,533–3,778) pg/ml and healthy adults 3,904 (2,732–5,463) pg/ml. Plasma ADTRP outperformed the other three inflammatory biomarkers (TNF-α, IL-6 and hs-CRP) for CAD (Area under ROC curve: 0.67, Odds ratio (OR): 0.907). Our study has shown for the first time that ADTRP is present in circulation, and that plasma ADTRP may be a novel independent biomarker for CAD.

Effect of Helicobacter pylori infection on the risk of acute coronary syndrome: A systematic review and meta-analysis

BACKGROUND

Numerous studies have illustrated the association between Helicobacter pylori (H pylori) infection and acute coronary syndrome (ACS). However, the results are contradictory. Therefore, we conducted the meta-analysis to identify the association between H pylori and ACS.

METHODS

We performed a systematic search through electronic databases (Excerpta Medica Database, PubMed, Cochrane Library, and Web of Science). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with a random effect model. We also carried out the sensitivity analysis and publication bias.

RESULTS

Forty-four eligible studies involving 7522 cases and 8311 controls were included. The pooled result showed that H pylori infection was associated with an increase risk of ACS (OR = 2.03, 95% CI 1.66-2.47). In addition, similar results were obtained in subgroups of study quality, area, human development index, and H pylori detection method. The OR for developing countries was significantly higher than developed countries (OR = 2.58 vs OR = 1.69). Moreover, H pylori with cytotoxin-associated antigen A was also significantly associated with an increase risk of ACS (OR = 2.39, 95% CI 1.21-4.74).

CONCLUSION

The meta-analysis suggested that H pylori infection was associated with an increased risk of ACS, especially in developing countries. H pylori is easily screened and can be treated with a wide range of drugs. Thus, more high-quality and well-designed studies are needed to confirm whether the treatment of H pylori is an effective way to reduce ACS risk.

Helicobacter pylori infection combined with non-alcoholic fatty liver disease increase the risk of atherosclerosis: Focus in carotid artery plaque

Atherosclerosis has severe consequences on human health. Carotid artery plaques are a condition typically caused by atherosclerosis. Previous studies showed that nonalcoholic fatty liver disease (NAFLD) and Helicobacter pylori (H pylori) are risks factors for carotid artery plaque formation. We hypothesize that the combination of NAFLD with H pylori infection increases the risk of carotid artery plaque formation.A total of 4669 subjects aged > 40 years who underwent routine health checkups between January 2006 and December 2015 were retrospectively reviewed. A serial examination, including abdominal ultrasound, carotid artery ultrasound and esophago-gastroduodenoscopy (EGD), and biopsy urease testing, was conducted.In total, 2402 subjects were enrolled. There were no differences in H pylori infection status among patients with or without NAFLD. There was a trend of more participants with both NAFLD and H pylori infection (number [N]=583) presenting carotid artery plaque (N = 187,32.08%) than participants without NAFLD and H pylori infection (N = 589) who presented plaque formation (N = 106, 18.00%). Participants who had both H pylori infection and NAFLD had the highest risk of any carotid artery plaque (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.413-2.636) based on a multivariate logistic regression analysis. This analysis also showed that age >60 years, male sex, low-density lipoprotein (LDL) >130 mg/dL, and H pylori infection were independent risk factors for concomitant NAFLD and carotid artery plaque formation.The combination of H pylori infection and NAFLD increases carotid artery plaque formation. H pylori eradication and NAFLD control may be warranted to prevent carotid artery plaque formation.

Contribution of Human Herpesvirus 8 and Herpes Simplex Type 2 to Progression of Carotid Intima-Media Thickness in People Living With HIV

Background

Human herpesvirus 8 (HHV-8) is a lymphotropic and vasculotropic herpesvirus with potential pro-atherogenic effects. We explored the influence of coinfection with HHV-8 and other herpesviruses on the rate of progression of carotid intima-media thickness (cIMT) in virologically suppressed people living with HIV (PLWH).

Methods

Prospective cohort study including men who have sex with men (MSM) infected with HIV. At the baseline visit, IgG antibodies against HHV-8 and other herpesviruses, highly sensitive C-reactive protein (hsCRP) levels, and Framingham risk scores were measured. To evaluate the progression of cIMT, successive measurements with high-resolution carotid artery ultrasound were performed over an 8-year period. Adjusted general linear mixed models were used to assess factors associated with faster cIMT progression.

Results

One hundred forty-one participants with suppressed HIV-RNA (<200 copies/mL) at cIMT measurement during the study period were included. Forty-six (31.3%) were coinfected with HHV-8 and 76 (54%) with herpes simplex virus 2 (HSV-2). Factors associated with faster cIMT progression adjusting for CD4 cell counts, time between cIMT measurements, hepatitis C, varicella zoster virus, and cytomegalovirus coinfection were seropositivity for HHV-8 (P = .059), HSV-2+HHV-8 coinfection (P = .027), Framingham risk score (P = .057), and hsCRP (P = .027). Coinfection with HHV-8 was independently associated with higher levels of hsCRP (odds ratio, 1.09; 95% confidence interval, 1.02 to 1.17; P = .016). When hsCRP and HHV-8 were simultaneously included in the adjusted model, the relationship of HHV-8 with cIMT progression was attenuated.

Conclusions

HHV-8 might contribute to progression of cIMT with a more prominent role when it coinfects with HHV-2 in virologically suppressed PLWH, and this effect could be driven by systemic inflammation.

Metals and oxidative potential in urban particulate matter influence systemic inflammatory and neural biomarkers: A controlled exposure study

BACKGROUND

Oxidative stress and inflammation are considered to be important pathways leading to particulate matter (PM)-associated disease. In this exploratory study, we examined the effects of metals and oxidative potential (OP) in urban PM on biomarkers of systemic inflammation, oxidative stress and neural function.

METHODS

Fifty-three healthy non-smoking volunteers (mean age 28 years, twenty-eight females) were exposed to coarse (2.5-10 μm, mean 213 μg/m³), fine (0.15-2.5 μm, 238 μg/m³), and/or ultrafine concentrated ambient PM (<0.3 μm, 136 μg/m³). Exposures lasted 130 min, separated by ≥2 weeks. Metal concentrations and OP (measured by ascorbate and glutathione depletion in synthetic airway fluid) in PM were analyzed. Blood and urine samples were collected pre-exposure, and 1-h and 21-h post exposure for assessment of biomarkers. We used mixed-regression models to analyze associations adjusting for PM size and mass concentration.

RESULTS

Results for metals were expressed as change (%) from daily pre-exposure biomarker levels after exposure to a metal at a level equivalent to the mean concentration. Exposure to various metals (silver, aluminum, barium, copper, iron, potassium, lithium, nickel, tin, and/or vanadium) was significantly associated with increased levels of various blood or urinary biomarkers. For example, the blood inflammatory marker vascular endothelia growth factor (VEGF) increased 5.3% (95% confidence interval: 0.3%, 10.2%) 1-h post exposure to nickel; the traumatic brain injury marker ubiquitin C-terminal hydrolase L1 (UCHL1) increased 11% (1.2%, 21%) and 14% (0.3%, 29%) 1-h and 21-h post exposure to barium, respectively; and the systemic stress marker cortisol increased 1.5% (0%, 2.9%) and 1.5% (0.5%, 2.8%) 1-h and 21-h post exposure to silver, respectively. Urinary DNA oxidation marker 8‑hydroxy‑deoxy‑guanosine increased 14% (6.4%, 21%) 1-h post exposure to copper; urinary neural marker vanillylmandelic acid increased 29% (3%, 54%) 1-h post exposure to aluminum; and urinary cortisol increased 88% (0.9%, 176%) 1-h post exposure to vanadium. Results for OP were expressed as change (%) from daily pre-exposure biomarker levels after exposure to ascorbate-related OP at a level equivalent to the mean concentration, or for exposure to glutathione-related OP at a level above the limit of detection. Exposure to ascorbate- or glutathione-related OP was significantly associated with increased inflammatory and neural biomarkers including interleukin-6, VEGF, UCHL1, and S100 calcium-binding protein B in blood, and malondialdehyde and 8-hydroxy-deoxy-guanosine in urine. For example, UCHL1 increased 9.4% (1.8%, 17%) in blood 21-h post exposure to ascorbate-related OP, while urinary malondialdehyde increased 19% (3.6%, 35%) and 8-hydroxy-deoxy-guanosine increased 24% (2.9%, 48%) 21-h post exposure to ascorbate- and glutathione-related OP, respectively.

CONCLUSION

Our results from this exploratory study suggest that metal constituents and OP in ambient PM may influence biomarker levels associated with systemic inflammation, oxidative stress, perturbations of neural function, and systemic physiological stress.

Cytomegalovirus infection in a patient with systemic lupus erythematosus and acute myocardial infarction - cause or causal relationship?

The possible role of infectious and inflammatory states in the pathogenesis of atherosclerotic disease has been a matter of debate in the literature. There are case reports of active cytomegalovirus (CMV) infection unmasking underlying dormant systemic lupus erythematosus (SLE). CMV infection has also been postulated to be associated with atherosclerosis development in the coronaries. We present a unique case where a patient with newly diagnosed SLE and acute myocardial infarction was found to have high anti-CMV titers suggesting concomitant active CMV infection. A literature review has postulated strong affiliation of CMV infection with the development of coronary artery disease, an avenue which has yet to be explored further by ongoing research.

Serum N1-Methylnicotinamide is Associated With Coronary Artery Disease in Chinese Patients

Background

We previously reported that serum N¹‐methylnicotinamide (me‐Nam), an indicator of nicotinamide N‐methyltransferase activity, is associated with obesity and diabetes mellitus in Chinese patients. However, whether nicotinamide N‐methyltransferase plays a role in human coronary artery disease (CAD) remains to be elucidated. We aim to investigate the associations of serum me‐Nam with CAD in Chinese patients.

Methods and Results

Serum me‐NAM was measured by liquid chromatography‐mass spectrometry in patients with (n=230) or without (n=103) CAD as defined by coronary angiography. The severity of CAD was expressed by number of diseased coronary arteries. Serum me‐Nam was higher (7.65 ng/mL versus 4.95 ng/mL, P<0.001) in patients with CAD than in those without. Serum me‐Nam was positively correlated with high‐sensitivity C‐reactive protein and negatively correlated with high‐density lipoprotein before and after adjustment for potential confounding variables (P≤0.002). In multivariable logistic regression analyses, compared with those in the lowest tertile of serum me‐NAM levels, patients in the top tertile had the highest risks for CAD (odds ratio, 4.21; 95% CI, 1.97–8.97 [P<0.001]). After adjustment for potential confounding variables, serum me‐NAM was also increased from 0‐ to 3‐vessel disease (P for trend=0.01).

Conclusions

Serum me‐Nam is strongly associated with presence and severity of CAD, suggesting nicotinamide N‐methyltransferase as a potential target for treating atherosclerosis in humans.

Association between Helicobacter pylori infection and angiographically demonstrated coronary artery disease: A meta-analysis

Coronary artery disease (CAD) is a leading cause of mortality globally. However, the etiology and pathogenesis of CAD are not fully understood. The aim of the present meta-analysis was to estimate the association between the risk of CAD and Helicobacter pylori (H. pylori) infection. A literature search was performed to identify eligible studies published prior to August 14, 2014. Fixed or random effect meta-analytical methods were used to pool the data and perform the subgroup analyses. The effect measures estimated were the odds ratios (OR) for dichotomous data reported with 95% confidence intervals (95% CI). Of the 109 studies identified using the search parameters, 26 cross-sectional studies were eligible involving 3,901 CAD patients and 2,751 controls. H. pylori infection was associated with an increased risk of CAD (OR: 1.96, 95% CI: 1.47-2.63, P<0.00001). When the adjusted ORs were used to conduct another meta-analysis, the OR value decreased, but the association remained significant (OR: 1.42, 95% CI: 1.09-1.86, P=0.008). The association between H. pylori infection and CAD risk was stronger in younger individuals than in older individuals (OR: 2.36, 95% CI 1.50-3.73 vs. OR: 1.59, 95% CI: 1.19-2.11). A significant association was observed in studies from Europe (OR: 2.11, 95% CI: 1.54-2.88, P=0.01) and the USA (OR: 1.43, 95% CI: 1.08-1.91, P=0.36). There is a potential association between H. pylori infection and the risk of CAD. The association may be influenced by age and ethnicity.

Relation of Neutrophil to Lymphocyte Ratio With Periprocedural Myocardial Damage in Patients Undergoing Elective Percutaneous Coronary Intervention

Neutrophil to lymphocyte ratio (NLR) has been proposed as a marker of cardiovascular risk. The potential relation between NLR and periprocedural myocardial damage after percutaneous coronary intervention (PCI) is unclear. We enrolled 502 consecutive patients with stable coronary artery disease undergoing elective PCI. Blood samples were drawn in all patients at baseline, 6 hours, and 24 hours after PCI for complete blood cell count and cardiac biomarkers (creatine kinase-MB and troponin T [Tn-T]) assessment. NLR was calculated as the ratio between the absolute number of neutrophil over the absolute number of lymphocyte. Periprocedural myocardial infarction (PMI) was defined according to the 2012 universal definition of myocardial infarction. In the overall population, a significant postprocedural increase in NLR was observed (3.255 [2.763 to 3.995] at baseline, 4.430 [3.390 to 6.020] at 6 hours, 4.720 [3.940 to 5.750] at 24 hours, p <0.0001). PMI occurred in 33 patients (6.6%). Baseline NLR was similar in patients with and without PMI (3.250 [2.820 to 3.885] vs 3.260 [2.750 to 4.000], p = 0.898); however, patients who developed PMI showed significantly higher NLR both at 6 hours (5.750 [4.360 to 9.095] vs 4.370 [3.370 to 5.950], p <0.001) and 24 hours (5.180 [4.440 to 8.065] vs 4.670 [3.920 to 5.710], p = 0.003). Among patients who developed PMI, periprocedural NLR increase showed a moderate positive correlation with both creatine kinase-MB (rho = 0.377, p = 0.031) and troponin T increase (rho = 0.506, p = 0.003). In conclusion, preprocedural NLR values do not impact on the occurrence of PMI during elective PCI; however, PCI procedures induce a significant increase in NLR that seems to be proportional to the magnitude of periprocedural myocardial damage.

Human cytomegalovirus infection and vascular disease risk: A meta-analysis

BACKGROUND

Human cytomegalovirus (HCMV) infection has been associated with the acceleration of vascular disease. Numbers studies were conducted to analyze the association between HCMV infection and risk of vascular disease, but no clear consensus had been reached. The aim of this study was to confirm this relationship precisely by doing a systematic review and meta-analysis.

METHODS

We identified relevant studies through a search of PubMed and Embase. Studies were eligible for inclusion if they fulfilled all of the following selection criteria: (1) evaluating the association between HCMV infection and vascular disease; (2) case-control studies or nested case-control studies; (3) and supply the numbers (or percentage) of positivity for HCMV infection in cases and controls, respectively. Data were extracted and analyzed independently by two investigators. Ultimately, We included data from 68 studies, which altogether enrolled 12027 cases and 15386 controls from 24 countries.

RESULTS

HCMV IgG was detected 7376 in 10611 cases, HCMV IgM was detected 153 in 1486 cases and HCMV DNA was detected 654 in 2139 cases. Overall, people exposed to HCMV infection had higher risk than those not exposed for vascular disease (OR 1.70 [95% CI 1.43-2.03] IgG-based HCMV tests, 2.88 [95% CI 1.87-4.43] IgM-based HCMV tests and 2.56 [95% CI 1.46-4.49 PCR-based HCMV tests]). HCMV infection was clearly identified as a risk factor for vascular disease in Asian group, Caucasian group and other group, especially Asian group(OR 1.86 [95% CI 1.33-2.60] IgG-based HCMV tests, 3.57 [95% CI 1.94-6.60] IgM-based HCMV tests and 4.09 [95% CI 3.10-5.40 PCR-based HCMV tests]).

CONCLUSION

This meta-analysis suggested that HCMV infection is associated with an increased risk for vascular disease.

The role of immune activation in endotoxin-induced atherogenesis

Some infectious agents may contribute to atherosclerosis by maintaining a heightened state of inflammatory response. Although the risk for atherosclerosis was associated with elevated plasma levels of endotoxin, it is difficult to firmly establish what place endotoxin assumes in the etiology of this disease. As the ability for endotoxin to promote disease may depend on its ability to initiate an inflammatory response, it may be controlled by additional regulatory factors. We measured plasma levels of endotoxin and serum levels of neopterin and soluble interleukin-2 receptor in a random population of 402 men and women, 50—79 years old at the 1990 baseline evaluation (Bruneck Study). End point of the prospective survey was incident (early) atherosclerosis in the carotid arteries as assessed with duplex ultrasound. Subjects with high endotoxin levels (90th percentile) in combination with low neopterin or soluble interleukin-2 receptor levels (below median) did not differ from those with low endotoxin in their risk of incident atherosclerosis. The risk associated with high endotoxin, however, was markedly elevated in subjects with high (above median) neopterin or soluble interleukin-2 receptor levels. The study provides epidemiological evidence that the atherogenic potential of endotoxemia is affected by concomitant immune activation.

The relationship between serum levels of hs-CRP and coronary lesion severity

Background and aim

It is very important to know the risk factors of coronary artery disease and the role of inflammatory markers. One of these markers is hs-CRP that has been indicated to increase in patients with coronary artery atherosclerosis. The main objective of this study was to determine the relationship between serum levels of hs-CRP and coronary lesion severity.

Methods

In the current study, we evaluated the role of hs-CRP in coronary artery disease and measured the relationship between serum hs-CRP levels and the severity of coronary lesions in 102 patients who referred to Imam Khomeini Hospital, Iran. The number of involved coronary arteries was measured. The severity of coronary lesions was evaluated by Gensini scoring method and the association between severity of coronary artery lesions and serum hs-CRP levels and other risk factors were examined.

Results

No significant difference was found between the two groups in terms of gender. Severity of lesions had no significant difference according to Gensini score in women compared with men. Mean Gensini score was significant between the two groups (66.79±48.12 in hs-CRP positive group versus 21.09±26.25 in negative ones, p<0.05). In addition, diabetic patients were significantly more in hs-CRP positive group than negative hs-CRP group (P<0.05). In terms of smoking, there was a significant difference between the two groups. Percentage of patients with hypercholesterolemia was significantly higher in hs-CRP negative group. There was a significant difference in severity of lesions between smokers and non-smokers.

Conclusion

No significant correlation was observed between serum levels of hs-CRP and severity and angiographic extent on coronary arteries in our study. Considering the potential risk of coronary inflammatory process as a new variable, it can help discover new cases of coronary lesions and follow-up and control of the selected cases.

Chlamydia pneumoniae-Mediated Inflammation in Atherosclerosis: A Meta-Analysis

Several studies have attempted to relate the C. pneumoniae-mediated inflammatory state with atherosclerotic cardiovascular diseases, providing inconsistent results. Therefore, we performed a meta-analysis to clarify whether C. pneumoniae may contribute to the pathogenesis of atherosclerosis by enhancing inflammation. 12 case-control, 6 cross-sectional, and 7 prospective studies with a total of 10,176 patients have been included in this meta-analysis. Odds Ratio (OR) with a 95% confidence interval was used to assess the seroprevalence of C. pneumoniae and differences between levels of inflammatory markers were assessed by standard mean differences. Publication bias was performed to ensure the statistical power. hsCRP, fibrinogen, interleukin- (IL-) 6, TNF-α, and IFN-γ showed a significant increase in patients with atherosclerosis compared to healthy controls (P < 0.05), along with a higher seroprevalence of C. pneumoniae (OR of 3.11, 95% CI: 2.88–3.36, P < 0.001). More interestingly, hsCRP, IL-6, and fibrinogen levels were significantly higher in C. pneumoniae IgA seropositive compared to seronegative atherosclerotic patients (P < 0.0001). In conclusion, the present meta-analysis suggests that C. pneumoniae infection may contribute to atherosclerotic cardiovascular diseases by enhancing the inflammatory state, and, in particular, seropositivity to C. pneumoniae IgA, together with hsCRP, fibrinogen, and IL-6, may be predictive of atherosclerotic cardiovascular risk.

Effects of ambient coarse, fine, and ultrafine particles and their biological constituents on systemic biomarkers: a controlled human exposure study

BACKGROUND

Ambient coarse, fine, and ultrafine particles have been associated with mortality and morbidity. Few studies have compared how various particle size fractions affect systemic biomarkers.

OBJECTIVES

We examined changes of blood and urinary biomarkers following exposures to three particle sizes.

METHODS

Fifty healthy nonsmoking volunteers, mean age of 28 years, were exposed to coarse (2.5-10 μm; mean, 213 μg/m3) and fine (0.15-2.5 μm; mean, 238 μg/m3) concentrated ambient particles (CAPs), and filtered ambient and/or medical air. Twenty-five participants were exposed to ultrafine CAP (< 0.3 μm; mean, 136 μg/m3) and filtered medical air. Exposures lasted 130 min, separated by ≥ 2 weeks. Blood/urine samples were collected preexposure and 1 hr and 21 hr postexposure to determine blood interleukin-6 and C-reactive protein (inflammation), endothelin-1 and vascular endothelial growth factor (VEGF; vascular mediators), and malondialdehyde (lipid peroxidation); as well as urinary VEGF, 8-hydroxy-deoxy-guanosine (DNA oxidation), and malondialdehyde. Mixed-model regressions assessed pre- and postexposure differences.

RESULTS

One hour postexposure, for every 100-μg/m3 increase, coarse CAP was associated with increased blood VEGF (2.41 pg/mL; 95% CI: 0.41, 4.40) in models adjusted for O3, fine CAP with increased urinary malondialdehyde in single- (0.31 nmol/mg creatinine; 95% CI: 0.02, 0.60) and two-pollutant models, and ultrafine CAP with increased urinary 8-hydroxydeoxyguanosine in single- (0.69 ng/mg creatinine; 95% CI: 0.09, 1.29) and two-pollutant models, lasting < 21 hr. Endotoxin was significantly associated with biomarker changes similar to those found with CAPs.

CONCLUSIONS

Ambient particles with various sizes/constituents may influence systemic biomarkers differently. Endotoxin in ambient particles may contribute to vascular mediator changes and oxidative stress.

Helicobacter pylori Infection Increase the Risk of Myocardial Infarction: A Meta-Analysis of 26 Studies Involving more than 20,000 Participants

BACKGROUND

Myocardial infarction is a fatal cardiovascular disease and one of the most common death causes all around the world. The aim of the meta-analysis was to quantify the risk of myocardial infarction associated with Helicobacter pylori infection.

METHODS

A literature search was performed to identify studies published before 14 July, 2014, for relevant risk estimates. Fixed and random effect meta-analytical techniques were conducted for myocardial infarction.

RESULTS

Twenty-six case-control studies involving 5829 myocardial infarction patients and more than 16,000 controls were included. Helicobacter pylori infection was associated with an increased risk of myocardial infarction (OR: 2.10, 95%CI: 1.75-2.53, p = .06). We also discovered a significant association between the bacteria and risk of myocardial infarction in young people (OR: 1.93, 95% CI: 1.41-2.66, p = .07), in elder people (OR: 2.02, 95% CI: 1.60-2.54, p = .29), in Caucasians (OR: 2.29, 95% CI: 1.99-2.63, p = .12), and in Asians (OR: 1.75, 95% CI: 1.12-2.73, p = .08).

CONCLUSION

Our meta-analyses suggested a possible indication of relationship between Helicobacter pylori infection and the risk of myocardial infarction. The pathogenicity might not be affected by age and race. More researches should be conducted to explore the mechanisms involved.

Association of pathogen burden and hypertension: the Persian Gulf Healthy Heart Study

BACKGROUND

Chronic infection with cytomegalovirus (CMV), Chlamydia pneumoniae, herpes simplex virus 1 (HSV-1), and Helicobacter pylori may contribute to essential hypertension. However, the evidence now available does not clarify whether the aggregate number of pathogens (pathogen burden) may be associated with hypertension.

METHODS

Sera from 1,754 men and women aged ≥25 years were analyzed for immunoglobulin G antibodies to C. pneumoniae, HSV-1, H. pylori, and CMV using enzyme-linked immunosorbent assay. The aggregate number of seropositives to the studied viral and bacterial agents was defined as pathogen burden. Hypertension was defined according to World Health Organization criteria.

RESULTS

A total of 459 (26.3%) of the subjects had hypertension. In the hypertensive group, 4.2% had 0 or 1 pathogens present, 20.6% had 2, 43.2% had 3, and 32.1% had 4; in the normotensive group, 7.9% had 0 or 1, 28.4% had 2, 42.7% had 3, and 21.0% had 4. Of the 4 studied pathogens, H. pylori seropositivity showed a significant independent association with hypertension (odds ratio (OR) =1.37; 95% confidence interval (CI) =1.05-1.79; P = 0.02). In multiple logistic regression analyses, the pathogen burden did not show a significant independent association with hypertension. Coinfection with H. pylori and C. pneumoniae was significantly associated with hypertension compared with double seronegativity after adjustment for age, sex, chronic low-grade inflammation, and cardiovascular risk factors (OR = 1.68; 95% CI = 1.14-2.47; P = 0.008].

CONCLUSIONS

The pathogen burden was not associated with hypertension. However, coinfection with C. pneumoniae and H. pylori showed a significant association with essential hypertension, independent of cardiovascular risk factors and chronic low-grade inflammation.

Chlamydophila pneumoniae infection and cardiovascular disease

Atherosclerosis is a multifactorial vascular inflammatory process; however, the inciting cause for inflammation remains unclear. Two decades ago, Chlamydophila pneumoniae (formerly Chlamydia pneumoniae) infection was proposed as a putative etiologic agent. We performed a PubMed search using the keywords Chlamydia and atherosclerosis in a Boolean query to identify published studies on C. pneumoniae and its role in atherogenesis, and to understand research interest in this topic. We found 1,652 published articles on this topic between 1991 and 2011. We analyzed relevant published studies and found various serological, molecular, and animal modeling studies in the early period. Encouraged by positive results from these studies, more than a dozen antibiotic clinical-trials were subsequently conducted, which did not find clinical benefits of anti-Chlamydophila drug therapy. While many researchers believe that the organism is still important, negative clinical trials had a similar impact on overall research interest. With many novel mechanisms identified for atherogenesis, there is a need for newer paradigms in Chlamydophila-atherosclerosis research.

Molecular characteristics of Human Endogenous Retrovirus type-W in schizophrenia and bipolar disorder

Epidemiological and genome-wide association studies of severe psychiatric disorders such as schizophrenia (SZ) and bipolar disorder (BD), suggest complex interactions between multiple genetic elements and environmental factors. The involvement of genetic elements such as Human Endogenous Retroviruses type 'W' family (HERV-W) has consistently been associated with SZ. HERV-W envelope gene (env) is activated by environmental factors and encodes a protein displaying inflammation and neurotoxicity. The present study addressed the molecular characteristics of HERV-W env in SZ and BD. Hundred and thirty-six patients, 91 with BD, 45 with SZ and 73 healthy controls (HC) were included. HERV-W env transcription was found to be elevated in BD (P<10-4) and in SZ (P=0.012) as compared with HC, but with higher values in BD than in SZ group (P<0.01). The corresponding DNA copy number was paradoxically lower in the genome of patients with BD (P=0.0016) or SZ (P<0.0003) than in HC. Differences in nucleotide sequence of HERV-W env were found between patients with SZ and BD as compared with HC, as well as between SZ and BD. The molecular characteristics of HERV-W env also differ from what was observed in Multiple Sclerosis (MS) and may represent distinct features of the genome of patients with BD and SZ. The seroprevalence for Toxoplasma gondii yielded low but significant association with HERV-W transcriptional level in a subgroup of BD and SZ, suggesting a potential role in particular patients. A global hypothesis of mechanisms inducing such major psychoses is discussed, placing HERV-W at the crossroads between environmental, genetic and immunological factors. Thus, particular infections would act as activators of HERV-W elements in earliest life, resulting in the production of an HERV-W envelope protein, which then stimulates pro-inflammatory and neurotoxic cascades. This hypothesis needs to be further explored as it may yield major changes in our understanding and treatment of severe psychotic disorders.

Role of C-reactive protein in urological cancers: a useful biomarker for predicting outcomes

Based on increasing evidence of the association between cancer-related inflammation and the progression of cancer, the external symptoms of systemic inflammatory response has been shown to be an indicator for the prognosis of many malignancies, including urological cancers. C-reactive protein, a representative acute-phase reactant, is a significant and sensitive inflammatory marker that can be objectively measured using reliable assays in clinical practice worldwide. C-reactive protein has been shown to be significant in the prediction of outcomes of urological cancers. The elevation of C-reactive protein levels, which indicate the presence of cancer-associated systemic inflammatory response, is linked to poorer survival in patients with urological cancers, including renal cell carcinoma, upper urinary tract and bladder cancers, and prostate cancer. With this strong prognostic ability, C-reactive protein can be incorporated into prognostic models and will make them simpler and improve their predictive accuracy. Furthermore, the longitudinal change of C-reactive protein level, C-reactive protein kinetics, provides additional information on patient survival outcomes. As such, C-reactive protein can be used to monitor treatment efficacy and disease course using serial measurements. In testicular cancer, C-reactive protein is associated with a risk of late complications, such as cardiovascular disease, and with the development of second non-germ-cell cancer. Taken together, these findings show that C-reactive protein can act as an important biomarker for urological cancers. This review discusses the importance of C-reactive protein as a prognostic biomarker in urological cancers on the basis of the currently available evidence.

Cytomegalovirus infection and coronary heart disease risk: a meta-analysis

The chronic inflammatory process including cytomegalovirus (CMV) infection has been hypothesized to induce the progression of atherosclerosis in coronary heart disease (CHD). Numbers studies were conducted to analyze the association between CMV infection and risk of CHD, but no clear consensus had been reached. To assess this relationship more precisely, a meta-analysis was performed. The electronic databases PubMed, Embase, and CNKI were searched; data were extracted and analyzed independently by two investigators. Ultimately, 55 studies, involving 9,000 cases and 8,608 controls from six prospective studies (all with a nested case-control design) and 49 retrospective case-control studies were included. Overall, people exposed to CMV infection had an odds ratio (OR) of 1.67 (95% CI, 1.56-1.79) for CHD risk, relative to those not exposed. CMV infection was clearly identified as a risk factor for CHD in both prospective studies (OR, 1.31; 95% CI, 1.132-1.517) and retrospective studies (OR, 1.79; 95% CI, 1.659-1.939), and in both Asian group (OR, 2.69; 95% CI, 2.304-3.144) and non-Asian group (OR, 1.48; 95% CI, 1.371-1.600). Interestingly, in the subgroup analyses by detection methods of CMV, the increased risk (OR, 8.121) was greater among studies using polymerase chain reaction than the risk (OR, 1.561) among studies using enzyme-linked immunosorbent assay. In conclusion, this meta-analysis suggested that CMV infection is associated with an increased risk for CHD, especially among Asian populations.

Expressions of interleukin-1β and interleukin-6 within aortas and uteri of rats with various severities of ligature-induced periodontitis

To investigate the associations of periodontitis with histological lesions in some other organs, various severities of periodontitis were induced in rats by 3/0 silk ligatures tied around different numbers of their molar necks. Six weeks after the initial placement of ligatures, all rats were sacrificed by an anaesthetic overdose. The distances from the cemento-enamel junction to the alveolar bone crest within the placement zone of the ligature and their contralateral zone in groups L(2) and L(3) were measured. The levels of interleukin (IL)-1β and IL-6 in serum were assayed by enzyme-linked immunosorbent assay techniques, and those within aortas and uteri were measured by real-time polymerase chain reaction and by immunohistochemistry. We divided the ligature-induced periodontitis models into mild, moderate and severe rat periodontitis and observed that although no association between periodontitis and the serum concentrations of IL-1β was detected, the differences in the severity of rat periodontitis led to varying degrees of elevated expressions of IL-1β and IL-6 within aortas and uteri.

Role of C-reactive protein as a biomarker for renal cell carcinoma

The presence of a systemic inflammatory response has been thought to indicate poor prognosis in renal cell carcinoma, based on the assumption that the processes underlying such a response play important roles in the progression of renal cell carcinoma. C-reactive protein (CRP) is a representative acute-phase reactant whose concentration can be objectively measured using a variety of reliable standardized assays. To show that CRP could be an indicator of normal or pathologic processes, recent studies have revealed that CRP is a significant prognostic factor for metastasis and mortality in patients with renal cell carcinoma. Incorporating CRP levels into prognostic algorithms could make those algorithms simpler without reducing their predictive accuracy. Furthermore, CRP kinetics, the analysis of dynamic changes in CRP concentrations, has been shown to generate valuable information relevant to prognosis, specifically information on the likelihood of tumor aggressiveness. Therefore, dynamic changes of CRP concentration could indicate clinical pharmacologic response to therapeutic intervention. Taken together, we could conclude that CRP is a significant biomarker for renal cell carcinoma.

The influence of persistent pathogens on circulating levels of inflammatory markers: a cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis

Background

Systemic inflammation is linked to cardiovascular risk, but the influence of persistent pathogens, which are conventionally dichotomously categorized, on circulating levels of inflammatory markers is not clear. Antibody levels of pathogens have not been examined in relation to inflammation.

Methods

Using data from a subsample of the Multi-Ethnic Study of Atherosclerosis, we examined circulating levels of interleukin-6 (IL-6), C-reactive protein (CRP) and fibrinogen in relation to five common persistent pathogens: cytomegalovirus, herpes simplex virus-1, Hepatitis A virus, Helicobacter pylori and Chlamydia pneumoniae. We tested the hypothesis that the number of seropositive pathogens (based on conventional cut-off points) would not be as sensitive a marker of inflammation as immune response measured by antibody levels to pathogens.

Results

High antibody response to multiple pathogens showed graded and significant associations with IL-6 (p < 0.001), CRP (p = 0.04) and fibrinogen (p = 0.001), whereas seropositive pathogen burden did not. In multiple linear regression models, high antibody response to multiple pathogens maintained a positive association only with IL-6 (4.4% per pathogen exhibiting high antibody response, 95% CI 0.0-8.9).

Conclusions

High antibody response to pathogens was a more consistent marker of inflammatory outcomes compared to seropositivity alone and high antibody response to multiple pathogens was a stronger marker compared to any single pathogen.

Evaluation of the level of antibodies against Chlamydophila (Chlamydia) pneumoniae in post-surgery heart ischaemia patients and their clinical conditions - a six-year study

INTRODUCTION

Inflammatory conditions modulated by Chlamydophila (Chlamydia) pneumoniae are considered to play an important role in the onset of atherosclerosis. In this paper we present the results of progressive observation of C. pneumoniae antibody titres in patients who underwent coronary artery bypass graft (CABG).

MATERIAL AND METHODS

The objective of our research was a prospective observation of antibody titres in IgA and IgG class antibodies against C. pneumoniae using indirect immunofluorescence in a group of 155 post-surgery CABG patients suffering from heart ischaemia. The microbiological test results were compared with patients' present coronary complaints evaluated on the CCS scale during a six-year period.

RESULTS

Six years after CABG, 128 patients (82.6%) are still alive. During the study a positive serological conversion of antibody titres was observed in 36 patients in the IgA class antibodies, and in 26 patients in the IgG class. The group of patients with no antibodies against C. pneumoniae decreased from 23.2 to 3.4%, while the group of patients with antibodies in both IgG and IgA classes increased from 52.3 to 83.9%. The average CCS degree decreased from 3.18 before CABG to 1.65 in the present study.

CONCLUSIONS

These results show no connection between the serological symptoms of chronic C. pneumoniae infection and coronary complaints evaluated on the CCS scale during a six-year study on post-CABG patients suffering from heart ischaemia. The surgical treatment of heart ischaemia brought about long-term improvement in the coronary condition of the observed group of patients.

Soluble CD14 in periodontitis

Lipopolysaccharide (LPS) binds to soluble (s)CD14. We investigated which factors contribute to variations in sCD14 levels in periodontitis, a chronic infectious disease of tooth-supporting tissues associated with endotoxemia and leading to inflammation and subsequently loss of teeth. The sCD14 levels were determined by ELISA in healthy controls (n=57) and untreated patients (59 moderate and 46 severe) and their relation with markers of systemic inflammation (C-reactive protein levels, and leukocyte, neutrophil and lymphocyte counts) was assessed. Anti-Aggregatibacter actinomycetemcomitans and anti-Porphyromonas gingivalis IgG levels were established by ELISA and CD14(-260) genotype was determined in a TaqMan allelic discrimination assay. Increased levels of sCD14 were more frequent among periodontitis patients (P=0.026) and showed a severity-dependence with increasing levels of periodontal breakdown (P=0.008). In patients, levels of sCD14 correlated positively with CRP (P=0.043), leukocyte numbers (P=0.011) and negatively with anti-A. actinomycetemcomitans IgG (P=0.007). In a multivariate analysis, sCD14 levels were predicted by ethnicity, age, educational level, and in Caucasian subjects also by the severity of periodontal destruction, but not by anti-P. gingivalis IgG or the CD14(-260) genotype. Periodontitis is associated with elevated levels of sCD14.

Correlation among soluble markers and severity of disease in non-diabetic subjects with pre-mature coronary artery disease

Studies are lacking in literature, which demonstrate the cumulative impact of certain soluble markers in predicting the severity of CAD. Serum hsCRP, MMP-9, TIMP-1 and sRAGE levels were measured in non-diabetic 100 angiographically proven CAD patients (Group I) and 40 non-diabetic subjects with coronary risk factors and without any lesions (Group II). Increased levels of serum hsCRP, MMP-9, TIMP-1 and decreased levels of sRAGE were observed in Group I as compared to Group II. Gensini score, a measure for severity of CAD was found to be positively correlated with serum hsCRP, MMP-9, TIMP-1 and negatively with sRAGE. Multivariate analysis revealed serum MMP-9, hsCRP, sRAGE and family history as predictors of severity of CAD with a cumulative sensitivity and specificity of 92% and 82%, respectively. Cumulative impact of these soluble markers, in addition to the established markers will contribute to improve the predictive value for the assessment of disease severity.

C-reactive protein variations for different chronic somatic disorders

AIMS

To compare the levels of C-reactive protein (CRP) in a range of chronic disorders such as osteoporosis, asthma, diabetes, chronic bronchitis/emphysema, myocardial infarction, current oral infections, stroke, angina pectoris, hay fever, and fibromyalgia/chronic pain syndrome.

METHODS

In all, 5,323 men took part in the first and second health screening of the Oslo Study in 1972/73 and 2000. Questionnaire information on medical history recorded at the second screening was used to identify men with relevant diseases. Serum samples collected in 2000 were stored for later analyses of CRP. In 2000 the men were aged 48-77 years.

RESULTS

Men with self-reported myocardial infarction, asthma, diabetes, chronic bronchitis/ emphysema, osteoporosis or fibromyalgia/chronic pain syndrome had significantly elevated mean levels of CRP versus non-cases. Men with osteoporosis had the highest mean values of 6.53 versus 3.55 mg/l in participants without this disease. Cases of asthma also had an increased mean CRP level of 5.01 versus 3.47 mg/l in non-cases and in chronic bronchitis/emphysema the corresponding levels were 4.42 versus 3.59 mg/l. Men with diabetes had 4.53 versus 3.53 mg/l and men with myocardial infarction had 4.27 versus 3.59 mg/l. In fibromyalgia/chronic pain syndrome the values were 4.79 mg/l and 3.60 mg/l respectively.

CONCLUSIONS

Elevated CRP levels were observed in elderly men in a number of chronic diseases, indicating a persistent inflammatory response. Mean levels varied according to the disease and indicated a baseline level in the individuals with a particular disorder. This is useful knowledge when CRP is used in the clinic for infection and inflammation status.

Microbial risk factors of cardiovascular and cerebrovascular diseases: potential therapeutical options

Infection and inflammation may have a crucial role in the pathogenesis of atherosclerosis. This hypothesis is supported by an increasing number of reports on the interaction between chronic infection, inflammation, and atherogenesis. Assessment of serological and inflammatory markers of infection may be useful adjuncts in identifying those patients who are at a higher risk of developing vascular events, and in whom more aggressive treatments might be warranted.

The Relationship Between Plasma C-Reactive Protein Levels and Presence and Severity of Coronary Stenosis in Patients With Stable Angina

High-sensitivity C-reactive protein (hsCRP) is an inflammation marker and potential predictor of cardiovascular events. However, there is no consensus on the relationship between plasma hsCRP levels and angiographically documented severe coronary lesions in patients with stable angina pectoris. In this study we aimed to assess whether plasma levels of hsCRP can indicate the severity of the coronary artery disease (CAD) in patients with stable angina. A total of 52 subjects, who had undergone coronary angiography were divided into two groups as follows: those with stable angina (group 1, at least one coronary arteries stenosis >50%, n = 26) and normal (group 2, n = 26). Severity of CAD was evaluated by using the Gensini score index. For each group, the levels of hsCRP were measured. HsCRP levels were compared in the subjects with normal coronary arteries, and in those with one-, two-, and three-vessel CAD, and no significant differences among the groups were found (analysis of variance, p>0.05). There was no significant correlation between hsCRP levels and Gensini score index (r = 0.278, p = 0.169). We conclude that there is no relationship between hsCRP levels and the presence and severity of CAD in patients with stable angina.

Chronic inflammatory autoimmune disorders and atherosclerosis

Rheumatoid arthritis (RA), periodontal disease (PD), and coronary artery disease (CAD) are common chronic inflammatory diseases. RA is associated with accelerated vascular risk resulting in an increased prevalence of CAD with attendant early mortality and excess morbidity. RA and PD have a common pathobiology. Accordingly, the aim of this study was to evaluate the association between RA, PD, and CAD and the influence of systemic inflammatory factors. A total of 100 active RA patients of which 50 had established CAD and 50 had no CAD were assessed for PD. All subjects underwent a clinical, cardiac, dental, laboratory, and radiological evaluation. Blood samples were obtained and the level of high-sensitivity C-reactive protein (hs-CRP), total white blood counts (WBC), erythrocyte sedimentation rate (ESR), fibrinogen and tumor necrosis alpha (TNF-alpha), total cholesterol (TC), and high-density lipoprotein (HDL) were assayed. The findings of this study demonstrated an association between RA, PD, and CAD. The RA patients with CAD had significantly more PD than RA patients without CAD, P < 0.001. The inflammatory markers hs-CRP, ESR, WBC, fibrinogen, and TNF-alpha were raised in all patients but were significantly higher in RA patients with CAD who also had PD, that is, in those with more inflammatory disease burden. HDL levels were lower in RA patients with CAD when compared to RA patients without CAD, P < 0.005. Evidence from this study shows an association between RA, PD, CAD, and systemic levels of the inflammatory mediators. The implication is that inflammation may be the central link between the chronic inflammatory autoimmune disorders and atherosclerosis.

Rheumatoid arthritis, periodontal disease and coronary artery disease

Rheumatoid arthritis (RA), periodontal disease (PD), and coronary artery disease (CAD) are common chronic inflammatory diseases. RA is associated with accelerated vascular risk resulting in an increased prevalence of CAD with attendant early mortality and excess morbidity. RA and PD have a common pathobiology. Accordingly, the aim of this study was to evaluate the association between RA, PD, and CAD and the influence of systemic inflammatory factors. A total of 100 active RA patients of which 50 had established CAD and 50 had no CAD were assessed for PD. All subjects underwent a clinical, cardiac, dental, laboratory, and radiological evaluation. Blood samples were obtained, and the level of high sensitivity C-reactive protein (hs-CRP), total white blood counts (WBC), erythrocyte sedimentation rate (ESR), fibrinogen and tumor necrosis factor (TNF) alpha, total cholesterol (TC), and high density lipoprotein (HDL) were assayed. The findings of this study demonstrated an association between RA, PD, and CAD. The RA patients with CAD had significantly more PD than RA patients without CAD. The inflammatory markers, hsCRP, ESR, WBC, fibrinogen, and TNF-alpha, were raised in all patients but were significantly higher in RA patients with CAD who also had PD. HDL levels were lower in RA patients with CAD when compared to RA patients without CAD. Evidence from this study shows an association between RA, PD, CAD, and systemic levels of the inflammatory mediators. The implication is that inflammation may be the central link between the chronic inflammatory, autoimmune disorders, and atherosclerosis.

Relationship between Chlamydia pneumoniae infection, inflammatory markers, and coronary heart diseases

Chlamydia pneumoniae is an intracellular pathogen and an important cause of respiratory tract infections in humans and more recently it has been associated with chronic diseases such as atherosclerosis. Numerous studies have been performed to show the "infectious" hypothesis of atherosclerosis by direct detection of the organisms within atheromatous plaques by seroepidemiological estimation and by animal, immunological and antibiotic interventional studies. In this work we investigated the relation between chronic chlamydial infection, inflammatory markers, Interleukin 7 (IL-7) production and coronary heart disease. We studied 60 patients with coronary heart diseases (CHD), 45 of whom were men and 15 women, with a mean age of 65+/-5 years, and a control group of 20 healthy subjects, 15 men and 5 women, with a mean age of 60+/-7 years. Detailed histories including symptoms, risk factors and demographic data were obtained from patients and healthy subjects by administering a standardized questionnaire. Our results demonstrate that the enzyme-linked immunoassay (ELISA) test appears to have a greater sensitivity than the microimmunofluorescence (MIF) technique. 80% of patients had positive IgG to C. pneumoniae and 58% positive IgA to C. pneumoniae with ELISA, while the MIF test showed 68% and 55% positive IgG and IgA to C. pneumoniae, respectively. The control subjects showed 55% positive IgG and 10% IgA to C. pneumoniae by ELISA and 35% positive IgG and 5% IgA to C. pneumoniae by MIF. The combination of positive IgG and IgA to C. pneumoniae was present more frequently than in the control group. Serum levels of IL-7 measured by ELISA were also significantly higher in patients compared to healthy subjects. In conclusion, our study shows that C. pneumoniae IgG and IgA seropositivity, inflammatory markers such as IL-7, fibrinogen, C-reactive protein were significantly correlated with CHD.

Investigation of Chlamydia pneumoniae DNA, chlamydial lipopolisaccharide antigens, and Helicobacter pylori DNA in atherosclerotic plaques of patients with aortoiliac occlusive disease

BACKGROUND AND INTRODUCTION

It has been suggested that chronic infections may have a role in both the initiation and progression of atherosclerosis. While the majority of available data are focused on coronary artery disease, our aim was to investigate the presence of Chlamydia pneumoniae and Helicobacter pylori in samples from aortoiliac occlusive disease.

METHODS

Aorta-iliac atherectomy specimens were collected under sterile conditions from 21 patients (19 male, 2 female) undergoing surgery for aortoiliac occlusive disease. Seventeen macroscopically healthy vessels (12 internal mammary arteries, 3 radial arteries, prepared for coronary artery bypass graft, and 2 traumatic artery specimens, one of which was a superficial femoral artery and the other was a radial artery) were used as control. Blood samples for serological assays were obtained immediately before surgery. The polymerase chain reaction (PCR) was employed to search for H. pylori and C. pneumoniae DNA in atherosclerotic plaques and healthy vessel samples. Group-specific chlamydial lipopolysaccharide (LPS) antigens in atherosclerotic plaques and in healthy vessel samples and serum IgG antibodies to chlamydial LPS were determined by using a commercially available enzyme-linked immunosorbent assay (ELISA). Antibodies to H. pylori were also tested in all cases by means of an in-house ELISA.

RESULTS

Chlamydial LPS and DNA were detected in 6 of 21 (28.57%) atherosclerotic lesions using ELISA or PCR, respectively. There was no evidence of H. pylori DNA in any plaque specimens. All cases in which C. pneumoniae DNA was positive were also seropositive for antichlamydial LPS. Neither C. pneumoniae DNA nor antigen nor H. pylori DNA was found in the macroscopically healthy samples.

CONCLUSION

Our results suggest that C. pneumoniae but not, as proposed, H. pylori may be involved in the pathogenesis of aortoiliac atherosclerosis.

Is Helicobacter pylori infection a risk factor for acute coronary syndromes?

OBJECTIVES

To elucidate risk factors for acute coronary syndromes (ACS), the present study examined whether Helicobacter pylori infection is a risk factor for patients with ACS.

METHODS

We studied 33 male patients with acute coronary syndromes (ACS). All patients were incidence cases of ACS that they did not have a past history of IHD and were at the first onset of ACS. A control group was consisted of 66 males. Controls were at random selected from outpatients. All controls had normal resting electrocardiogram and had no history of IHD. H. pylori seropositivity was determined by an IgG-specific enzyme linked immunosorbent assay (ELISA). We serologically confirmed the presence of antibodies specific to the antigen CagA of H. pylori, using CagA ELISA.

RESULTS

Seropositive rate of IgG antibodies in patients with ACS was 87.9%. A rate of in controls was 66.7%. After adjustment for age, a statistically significant association was found in H. pylori seropositivity between ACS and controls (OR, 3.74; 95% CI, 1.15-12.13). This relation was also significant after adjusted for potential confounding factors (OR, 4.09; 95% CI, 1.10-15.17). Anti-CagA positive H. pylori were significantly recognized in ACS (adjusted OR, 3.58; 95% CI, 1.08-11.82). However, this significant association was disappeared after adjusted for potential confounding factors (P=0.054).

CONCLUSIONS

We confirmed a significant link between H. pylori infection and ACS. H. pylori infection is likely to be a risk factor for ACS.

Prevalence of Helicobacter pylori infection and its association with cardiovascular risk factors in Korean adults

OBJECTIVE

The purpose of this study is to evaluate the prevalence of Helicobacter pylori (H. pylori) infection and its association with cardiovascular risk factors in healthy Korean adults. In 58981 subjects who participated in health screening program, the proportion of seropositive subjects for H. pylori and its association with cardiovascular risk factors was evaluated.

RESULTS

A total of 70.9% of participants were tested positive for the H. pylori antibody. The seropositivity was highest in the age group of 50 and 60 years old. More male subjects tended to be infected with H. pylori (p<0.05) than female subjects except for the age group of 50s. H. pylori seropositive subjects tended to be older than seronegative subjects (41.5 vs. 39.2 years old). After adjusting for age, H. pylori-seropositive group showed higher mean values for total cholesterol, triglyceride, low-density lipoprotein (LDL)-cholesterol, apolipoprotein B and lower values for high-density lipoprotein (HDL)-cholesterol, apolipoprotein A1 (p<0.05). In univariate correlation analysis, age, total cholesterol, LDL-cholesterol and apolipoprotein B were positively correlated and HDL-cholesterol and apolipoprotein A1 were negatively correlated with H. pylori immunoglobulin G (IgG) titers (p<0.05). The multiple analysis of covariance analysis (MANCOVA) for the H. pylori infection status showed triglyceride, HDL-cholesterol and apolipoproteins associated with H. pylori infection significantly (p<0.05). In the analysis performed only in the H. pylori-seropositive group, no difference between the groups with and without peptic ulcer were shown according to the risk factors except HDL-cholesterol (p=0.031).

CONCLUSIONS

H. pylori infection is prevalent in Korean adults and is associated with cardiovascular risk factors, especially with triglyceride, HDL-cholesterol and apolipoproteins, independently from the presence of peptic ulcer. This is in line with the previous study results in which H. pylori infection per se might be one of the factors affecting atherosclerosis through modulation of lipid profiles, which needs further research.