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

Citation
Jb. Muhlestein et al., Cytomegalovirus seropositivity and C-reactive protein have independent andcombined predictive value for mortality in patients with angiographically demonstrated coronary artery disease, CIRCULATION, 102(16), 2000, pp. 1917-1923
Citations number
36
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
CIRCULATION
ISSN journal
0009-7322 → ACNP
Volume
102
Issue
16
Year of publication
2000
Pages
1917 - 1923
Database
ISI
SICI code
0009-7322(20001017)102:16<1917:CSACPH>2.0.ZU;2-A
Abstract
Background-The role of inflammation in coronary artery disease (CAD) is bei ng increasingly recognized. Markers of inflammation (eg, C-reactive protein [CRP]) and infection (eg, seropositivity to Chlamydia pneumoniae, cytomega lovirus [CMV], and Helicobacter pylori) have been proposed as risk factors for CAD, but these associations require further evaluation. Methods and Results-We prospectively tested whether CRP levels and IgG sero positivity to C pneumoniae, CMV, and H pylori are predictors of subsequent mortality in 985 consecutive patients with angiographically demonstrated CA D (stenosis greater than or equal to 70%). Patients were followed for an av erage 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 s ignificantly 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<0.05) was predictive of mortality. The majority of mortality risk associated with elevated CRP or CMV seropositivity occurred when both risk factors were present (P for t rend <0.0001). Other independent predictors of increased risk of mortality were age (HR=1.07 per year, P<0.0001), left ventricular ejection fraction ( HR=0.97 per percent, P<0.0001), and diabetes mellitus (HR=1.7, P=0.02). Conclusions-CMV seropositivity and elevated CRP, especially when in combina tion, are strong, independent predictors of mortality in patients with CAD. This suggests an interesting hypothesis that a chronic, smoldering infecti on (CMV) might have the capacity to accelerate the atherothrombotic process .