Cytomegalovirus seropositivity and C-reactive protein have independent and combined predictive value for mortality in patients with angiographically demonstrated coronary artery disease

• Published in: Circulation (New York, N.Y.) N.Y.), 2000-10, Vol.102 (16), p.1917-1923
• Main Authors: MUHLESTEIN, Joseph B, HORNE, Benjamin D, CARLQUIST, John F, MADSEN, Troy E, BAIR, Tami L, PEARSON, Robert R, ANDERSON, Jeffrey L
• Format: Article
• Language: English
• Subjects: Aged; Antibodies, Bacterial - blood; Antibodies, Viral - blood; Biological and medical sciences; C-Reactive Protein - metabolism; Cardiology. Vascular system; Chlamydophila Infections - blood; Chlamydophila Infections - epidemiology; Chlamydophila pneumoniae - isolation & purification; Comorbidity; Coronary Angiography; Coronary Disease - blood; Coronary Disease - diagnostic imaging; Coronary Disease - mortality; Coronary heart disease; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - blood; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - mortality; Female; Follow-Up Studies; Heart; Helicobacter Infections - blood; Helicobacter Infections - diagnosis; Helicobacter Infections - epidemiology; Helicobacter pylori - isolation & purification; Humans; Immunoglobulin G - blood; Male; Medical sciences; Predictive Value of Tests; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Serologic Tests
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.102.16.1917

The role of inflammation in coronary artery disease (CAD) is being increasingly recognized. Markers of inflammation (eg, C-reactive protein [CRP]) and infection (eg, seropositivity to Chlamydia pneumoniae, cytomegalovirus [CMV], and Helicobacter pylori) have been proposed as risk factors for CAD, but these associations require further evaluation. We prospectively tested whether CRP levels and IgG seropositivity to C pneumoniae, CMV, and H pylori are predictors of subsequent mortality in 985 consecutive patients with angiographically demonstrated CAD (stenosis >/=70%). Patients were followed for an average of 2.7 years (range 1.5 to 4.0 years). Patients averaged 65 years of age; 77% were men; and 110 (11.2%) died during follow-up. CRP levels were significantly elevated in nonsurvivors compared with survivors (mean CRP 3.1 mg/dL versus 1.5 mg/dL, P:=0.003). After controlling for all known baseline variables, the 2nd and 3rd tertiles of CRP compared with the 1st produced a Cox hazard ratio (HR) for mortality of 2.4 (P:=0.001). Of the 3 infectious markers tested, only seropositivity to CMV (HR=1.9, P: