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Inflammation and Coronary Heart Disease
There is growing interest in the role of chronic inflammation -- possibly mediated by infection -- in the pathogenesis of coronary heart disease (CHD). Because most studies have been cross-sectional, it has been difficult to draw conclusions about cause and effect. In this large prospective study, researchers tried to clarify this relationship.
The study involved 5661 British men (age range, 40 to 59) who underwent testing for several measures of inflammation (C-reactive protein, serum amyloid A, albumin, and leucocyte count) from 1978 through 1980. All participants subsequently were monitored for cardiovascular and all-cause mortality. By 1996, 506 men had suffered major adverse coronary events; these men were compared with 1025 controls who had remained disease-free.
For C-reactive protein and amyloid A levels, when men with levels in the top third at baseline were compared to those with levels in the bottom third, a significant association with CHD was seen after adjustment for age, town, smoking, vascular risk factors, and socioeconomic status (odds ratios, 2.13 for C-reactive protein and 1.65 for amyloid A); the same analytic scheme yielded nonsignificant ORs of 1.12 and 0.67 for leukocyte count and albumin, respectively. Inflammation marker levels were not associated with Helicobacter pylori seropositivity, Chlamydia pneumoniae antibody titers, or plasma homocysteine concentrations.
In a second report, the investigators found no significant relation between chlamydia antibody titers and CHD in the same cohort. This conclusion was supported by a meta-analysis of 15 other prospective studies.
Comment: These results add considerably to the supposition that chronic inflammation is associated with greater risk for CHD. This inflammation does not appear to be associated with selected infections.
— KI Marton
Published in Journal Watch General Medicine August 29, 2000
Citation(s):
Danesh J et al. Low grade inflammation and coronary heart disease: Prospective study and updated meta-analyses. BMJ 2000 Jul 22 321 199-204.
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- Medline abstract (Free)
Danesh J et al. Chlamydia pneumoniae IgG titres and coronary heart disease: Prospective study and meta-analysis. BMJ 2000 Jul 22 321 208-212.
- Original article (Subscription may be required)
- Medline abstract (Free)