Enterovirus, mycoplasma and other infections as predictors for myocardial infarction

Abstract

Abstract. Reunanen A, Roivainen M, Kleemola M, Saikku P, Leinonen M, Hovi T, Knekt P, Leino A, Aromaa A (National Public Health Institute, Helsinki and Oulu; Social Insurance Institution, Turku; University Hospital, Turku, Finland). Enterovirus, mycoplasma and other infections as predictors for myocardial infarction. Journal of Intern Med 2002; 252: 421-429.Objectives. To study antibodies against five infectious agents for their prediction of major coronary events in men with and without evidence of coronary heart disease at baseline. Design. A case-control study nested within a prospective population study. Subjects. The study cases included 441 men 45-64 years old with nonfatal myocardial infarction or coronary death within a mean follow-up time of 10 years. A total of 165 men had already signs of heart disease at baseline, whilst 276 were apparently healthy at the beginning of the study. Two controls for each case were matched for age, heart disease status and place of residence. Antibodies against enterovirus, Mycoplasma pneumoniae, Chlamydia pneumoniae, cytomegalovirus and adenovirus were determined. Results. Men without reported baseline heart disease, but not those with heart disease, showing the highest quartile of antibodies to enterovirus and mycoplasma or increased levels of immune complex-bound antibodies to chlamydia had a significantly higher risk of coronary events than men with lower level of antibodies. The increased risk demonstrated in men with high levels of antibodies to enterovirus and mycoplasma remained significant after adjustment for other antibodies, acutephase reactant and conventional risk factors. Serological evidence of infection by multiple agents was also significantly associated with coronary events. Conclusions. Serological evidence for several infectious agents is associated with the risk of coronary heart disease, but only in men without baseline history of heart disease.

Dual role of infections as risk factors for coronary heart disease

“…However, in an earlier study there was no correlation of hypertension and diabetes on microbial titers [5]. This could be shown also in the patients in this study.…”

“…Actually there was a trend of the titers being higher in those with earlier infarction which is in contrast to the study of Reunanen et al [5]. The risk for coronary event was associated with high EV, HV and C. pneumoniae pneumoniae bacteria have been considered as the main vascular pathogens increasing the risk for CHD [10].…”

“…High titers against EV common antigen in sera of men without evidence of heart disease taken years before the coronary attack have been reported in two large population studies [4,5] but not confirmed in a third study of dyslipidemic men [6]. The time span between antibody measurements and the actual event was years.…”

“…The observed antibody responses for microbes in our study may reflect acute but also reactivated latent or chronic infections. Their effect seems not to be mediated by the known risk factors such as hypertension and diabetes [5].…”

An enterovirus strain isolated from diabetic child belongs to a genetic subcluster of echovirus 11, but is also neutralised with monotypic antisera to coxsackievirus A9

“…Infections of this virus group are also known to cause acute and chronic myocarditis in humans. More recently, infections caused by EV have been associated to atherosclerotic disease, myocardial infarction (Reunanen et al, 2002(Reunanen et al, , 2005Roivainen et al, 1998aRoivainen et al, , 1999, type 1 diabetes (T1D; Andreoletti et al, 1997;Clements et al, 1995;Hyoty et al, 1995;Roivainen et al, 1998b) and also to bronchiolitis and asthma (Jartti et al, 2004).…”