Human Cytomegalovirus Linked to Stroke in a Chinese Population

Huang, Zhengrong; Yu, Liping; Yang, Xinchun; Zhang, Fan; Chen, You-Ren; Feng, Fang; Qian, Xiaosen; Cai, Jun

doi:10.1111/j.1755-5949.2012.00326.x

Cited by 25 publications

(22 citation statements)

References 20 publications

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“…That study found that the risk of cerebrovascular disease was higher among HIV patients who were CMV-seropositive at baseline than among those who were CMV-seronegative (AHR 2.27; 95% CI 0.97–5.32; P = 0.058). 26 Although the ICoNA study was the first cohort study of the link between CMV infection and stroke, it was limited by the small number of cerebrovascular events (n = 6). Time-dependent analysis in the present study showed that CMV infection was an independent predictor of incident ischemic stroke among HIV patients.…”

Section: Discussionmentioning

confidence: 99%

Association of HIV and Opportunistic Infections With Incident Stroke: A Nationwide Population-Based Cohort Study in Taiwan

Yen

Chen

Jen

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background HIV-associated vasculopathy and opportunistic infections (OIs) might cause vascular atherosclerosis and aneurysmal arteriopathy, which could increase the risk of incident stroke. However, few longitudinal studies have investigated the link between HIV and incident stroke. This cohort study evaluated the association of HIV and OIs with incident stroke. Methods We identified adults with HIV infection in 2000–2012, using the Taiwan National Health Insurance Research Database. A control cohort without HIV infection, matched for age and sex, was selected for comparison. Stroke incidence until December 31, 2012 was then ascertained for all patients. A time-dependent Cox regression model was used to determine the association between OIs and incident stroke among HIV patients. Results Among a total of 106,875 patients (21,375 HIV patients and 85,500 matched controls), stroke occurred in 927 patients (0.87%) during a mean follow-up period of 5.44 years, including 672 (0.63%) ischemic strokes and 255 (0.24%) hemorrhagic strokes. After adjusting for other covariates, HIV infection was an independent risk factor for incident all-cause stroke [adjusted hazard ratio (AHR) 1.83; 95% confidence interval (CI) 1.58–2.13]. When type of stroke was considered, HIV infection increased the risks of ischemic (AHR 1.33; 95%CI 1.09–1.63) and hemorrhagic stroke (AHR 2.01; 95%CI 1.51–2.69). The risk of incident stroke was significantly higher in HIV patients with cryptococcal meningitis (AHR 4.40; 95%CI 1.38–14.02), cytomegalovirus disease (AHR 2.79; 95%CI 1.37–5.67), and Penicillium marneffei infection (AHR 2.90; 95%CI 1.16–7.28). Conclusions HIV patients had an increased risk of stroke, particularly those with cryptococcal meningitis, cytomegalovirus, or P. marneffei infection.

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Section: Discussionmentioning

confidence: 99%

Association of HIV and Opportunistic Infections With Incident Stroke: A Nationwide Population-Based Cohort Study in Taiwan

Yen

Chen

Jen

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…It has been implicated in transplant vasculopathy [27], atherosclerosis [5], coronary heart disease [7], and hypertension [28]. Also has been implicated in the development of stroke, but with conflicting results [4][5][6][7]11]. In our group of patients, a significant association was observed between ischaemic stroke and high levels of IgG antibodies to CMV.…”

Section: Discusionmentioning

confidence: 59%

“…However, the occurrence of stroke in populations is incompletely explained by traditional vascular risk factors [1]. Case-control and prospective studies indicate that infection with a persistent pathogen, as Chlamydia pneumoniae or cytomegalovirus, might increase stroke risk, although considerable variation exists in the results [2][3][4][5][6][7][8][9][10][11]. These types of microorganisms are never completely cleared from the host, and as a result, they could reactivate and promote and/or worsening of atherosclerosis.…”

Section: Introductionmentioning

confidence: 99%

Persistent Q fever and ischaemic stroke in elderly patients

González-Quijada

Salazar-Thieroldt

Mora-Simón

2015

Clinical Microbiology and Infection

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Whether persistent or chronic Q fever may act as a risk factor for stroke is unknown. A case-control study was conducted in the Hospital Universitario de Burgos (Spain) between February 2011 and December 2012. A total of 803 samples from 634 consecutive hospitalized patients ≥65 years old were tested, of whom 111 were cases (patients with prevalent or incident ischaemic stroke and/or transient ischaemic attack) and 523 were controls (patients without ischaemic stroke and/or transient ischaemic attack). Immunoglobulin G (IgG) antibody titres phase I and II against Q fever, and IgG antibodies levels against Chlamydia pneumoniae and cytomegalovirus (CMV), were determined using immunofluorescence assay and ELISA methods, respectively. Phase I IgG titres against Coxiella burnetii ≥1:256 (compatible with chronic or persistent Q fever) were detected in 16 of 110 (14.5%) cases and in 32 of 524 (6.1%) controls; P = .004, odds ratio (OR) 2.6, 95% confidence interval (CI) 1.3 to 4.9. This ratio was maintained after adjusting for age, sex, hypertension, dyslipidaemia, cardioembolic focus, smoking, diabetes, other cardiovascular diseases, C-reactive protein, and leukocyte count (OR 2.6, 95% CI 1.3 to 5.3). High-titre IgG antibodies (top quartile) against CMV (OR 2.1, 95% CI 1.3 to 3.5), but not against C. pneumoniae (OR 0.9, 95% CI 0.5 to 1.6), also were associated with ischaemic stroke after adjustment for risk factors. In conclusion, serology compatible with persistent or chronic Q fever is associated with ischaemic stroke in elderly patients. High levels of IgG antibodies against CMV, but not against C. pneumoniae, also are associated with ischaemic stroke in these patients.

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“…10 Results from another case-control study demonstrated that HCMV DNA was related to both ischemic and hemorrhagic stroke. 12 The present study revealed that HCMV infection was independently associated with the risk of total and hemorrhagic stroke, but not with ischemic stroke, in hypertensive patients from rural areas of China. Despite the negative association between HCMV infection and ischemic stroke, we believe that these data alone cannot exclude a potential role for HCMV infection in the development of ischemic stroke.…”

Section: Resultsmentioning

confidence: 84%

“…In a recent case-control study, Huang et al demonstrated that HCMV seropositivity was higher in the stroke group than in controls (55.0% vs. 23.5%, P<0.05) and the presence of HCMV DNA increased the risk of stroke. 12 However, there are also a few epidemiological studies that have found different results. 13, 14 In a prospective study over a 12-year follow-up period, Ridker et al found that IgG antibodies directed against CMV do not appear to be a marker for increased risk of future stroke (hazard ratio: 0.72, 95% confidence interval (CI), 0.6-0.9).…”

mentioning

confidence: 99%

Human Cytomegalovirus Increases the Risk of Future Hemorrhagic But Not Ischemic Stroke　– A Nested Case-Control Study –

Zheng

Sun

et al. 2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp retrospective studies have reported an increased risk of stroke and coronary artery disease (CAD) in association with HCMV infection. 8-12 Guech-Ongey et al 8 and Potena et al 9 reported a positive association between HCMV infection and cardiovascular disease (CVD), and indicated that HCMV infection is one of the main causes in cerebral infarction patients. In a recent case-control study, Huang et al demonstrated that HCMV seropositivity was higher in the stroke group than in controls (55.0% vs. 23.5%, P<0.05) and the presence of HCMV DNA increased the risk of stroke. 12 However, there are also a few epidemiological studies that have found different results. 13,14 In a prospective study over a 12-year follow-up period, Ridker et al found that IgG antibodies directed against CMV do not appear to be a marker for increased risk of future stroke (hazard ratio: 0.72, 95% confidence interval (CI), 0.6-0.9). 13 In summary, the association between HCMV and risk of troke is the second commonest cause of death and the leading cause of adult disability worldwide. 1 Results from a large standardized case-control study (INTERSTROKE) indicate that traditional major risk factors for stroke include hypertension, current smoking, abdominal obesity, diet, and physical inactivity. 2 However, these risk factors cannot account for all of the global risk of all strokes. How to identify novel risk factors for stroke is still an urgent issue. 3 More recently, inflammation has been associated with an increased risk of cardiovascular events, including stroke. 4-6 Atherosclerosis is regarded as a chronic low-grade inflammation, initiated and deteriorated by a combination of classical risk factors and novel risk factors, such as viruses. Human cytomegalovirus (HCMV) belongs to the β-herpes virus subfamily, which after primary infection persists for the lifespan of the host. Background: The cause-and-effect relationship between human cytomegalovirus (HCMV) and stroke has not been widely elucidated. We aimed to determine if HCMV infection has an increased risk of future stroke in hypertensive patients in rural areas of China.

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Human Cytomegalovirus Linked to Stroke in a Chinese Population

Abstract: We demonstrate a novel link between HCMV infection and stroke. These findings may provide important insights into the pathogenesis of stroke.

Cited by 25 publications

References 20 publications

Association of HIV and Opportunistic Infections With Incident Stroke: A Nationwide Population-Based Cohort Study in Taiwan

Association of HIV and Opportunistic Infections With Incident Stroke: A Nationwide Population-Based Cohort Study in Taiwan

Persistent Q fever and ischaemic stroke in elderly patients

Human Cytomegalovirus Increases the Risk of Future Hemorrhagic But Not Ischemic Stroke　– A Nested Case-Control Study –

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Human Cytomegalovirus Linked to Stroke in a Chinese Population

Abstract: We demonstrate a novel link between HCMV infection and stroke. These findings may provide important insights into the pathogenesis of stroke.

Cited by 25 publications

References 20 publications

Association of HIV and Opportunistic Infections With Incident Stroke: A Nationwide Population-Based Cohort Study in Taiwan

Association of HIV and Opportunistic Infections With Incident Stroke: A Nationwide Population-Based Cohort Study in Taiwan

Persistent Q fever and ischaemic stroke in elderly patients

Human Cytomegalovirus Increases the Risk of Future Hemorrhagic But Not Ischemic Stroke – A Nested Case-Control Study –

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Product

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Human Cytomegalovirus Increases the Risk of Future Hemorrhagic But Not Ischemic Stroke　– A Nested Case-Control Study –