Objective-To test the hypothesis that minor chronic insults such as smoking, chronic bronchitis, and two persistent bacterial infections may be associated with increases in C reactive protein concentration within the normal range and that variations in the C reactive protein concentration in turn may be associated with levels of cardiovascular risk factors and chronic coronary heart disease.Design-Population based cross sectional study. Setting-General practices in Merton, Sutton, andWandsworth.Subjects-A random sample of 388 men aged 50-69 years from general practice registers. 612 men were invited to attend and 413 attended, of whom 25 non-white men were excluded. The first 303 of the remaining 388 men had full risk factor profiles determined.Interventions-Measurements ofserum C reactive protein concentrations by in house enzyme linked inmunosorbent assay (ELISA); other determinations by standard methods. Coronary heart disease was sought by the Rose angina questionnaire and Minnesota coded electrocardiograms.Main outcome measures-Serum C reactive protein concentrations, cardiovascular risk factor levels, and the presence of coronary heart disease.Results-Increasing age, smoking, symptoms of chronic bronchitis, Helicobacter pylori and Chlamrydia pneumoniae infections, and body mass index were all associated with raised concentrations of C reactive protein. C Reactive protein concentration was associated with raised serum fibrinogen, sialic acid, total cholesterol, triglyceride, glucose, and apolipoprotein B values. C Reactive protein concentration was negatively associated with high density lipoprotein cholesterol concentration. There was a weaker positive relation with low density lipoprotein cholesterol concentration and no relation with apolipoprotein A I value. C Reactive protein concentration was also strongly associated with coronary heart disease.

An increased anti-Cp antibody titre may be a predictor for further adverse cardiovascular events in post-MI patients. Taking a short course of azithromycin may lower this risk, possibly by acting against Cp.

Background-There is evidence suggesting that early life experience may influence adult risk of coronary heart disease (CHD). Chronic bacterial infections have been associated with CHD. Objective-To determine whether Helicobacter pylori, a childhood acquired chronic bacterial infection, is associated with an increased risk of coronary heart disease in later life. We used a case-control comparison to investigate whether H pylori infection was associated with adult CHD. We also studied possible associations of Hpylori infection with cardiovascular risk factors in the control population. Patients and methods PATlENTSWe studied men aged 45-65. The controls came from a single general practice screening clinic and the cases from a series of consecutive patients referred to the cardiology clinic of a local teaching hospital with angiographically confirmed CHD (stenosis >70% in one coronary artery). Potential controls were excluded if they had a firm diagnosis of CHD. METHODSAll subjects completed a questionnaire and 10 ml of serum was drawn and stored at -20°C. Blood pressure was measured in the general practice when the patient was seated. One observer used the same mercury sphygmomanometer throughout the study.We measured H pylori specific IgG antibody titres by an in-house enzyme linked immunoadsorbent assay (ELISA) in duplicate, using a partially purified antigen as described previously. Results were analysed by multiple logistic regression using GLIM7 and multiple regression using the GLM proceedure in SAS. In the logistic regression models, age was grouped into four categories (45-49, 50-54, 55-59, 60-65) and current social class was grouped into six categories according to the Registrar-General's 1980 classification.

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