Abstract
Background: We evaluated the role of Chlamydia pneumoniae ( C. pneumoniae ) and Cytomegalovirus (CMV) infection in coronary artery disease(CAD) patients. Interferon- γ (IFN-γ) levels in serum were assessed for ongoing inflammatory activity by these microorganisms. Methods: Persistent and chronic infection of C. pneumoniae was assessed by the level of IgA and IgG antibodies as well as 16S rRNA gene of C.pneumoniae . Chronic CMV presence was detected by IgG antibodies. IFN-γ levels in serum were analysed by ELISA. Results: Among the 63 CAD cases, C. pneumoniae IgG antibodies were present in 34(53.97%;95% CI: 41.66% to 66.28%) cases, C. pneumoniae IgA antibodies were detected in 42(66.67%; 95% CI :55.03% to78.31%) cases (p<0.05). PCR for detection of C. pneumoniae was done on 40 cases, among which 13 (32.5%; 95% CI: 17.99% to 47.01%) of cases were positive for 16SrRNA gene of C. pneumoniae . CMV IgG was positive in 41 (65.08%; 95% CI: 53.31% to 76.85%) cases. On assessing the patients of CAD for major traditional risk factors,35(55.55%) had past history of CAD, 20(31.75%) of dyslipidemia, 19 (30.16%) gave history of smoking and 18 (28.75%) were obese. On comparison of infectious etiology and traditional risk factors, it was clear that C. pneumoniae and CMV both were more (p<0.001) strongly associated with CAD than the traditional risk factors. Mean level of IFN-γ in these patients was 32.13pg/ml and that of controls was 11.32pg/ml. Raised IFN-γ was observed in 39 (61.9%) patients of which 14 (35.9%) were patients of primary hypertension, 7 (17.9%) were patients of angina and 18 (46.15%) were patients of MI. Conclusions: C. pneumoniae and chronic CMV infection appear to have a role in the pathogenesis of CAD. Elevated IFN-γ levels suggests that these pathogens aggravate the inflammatory process of atherogenesis and hasten the disease process. DOI: 10.21276/APALM.1551
Highlights
Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide
Among the 63 CAD cases, C. pneumoniae IgG antibodies were present in 34(53.97%;95% CI: 41.66% to 66.28%) cases, C. pneumoniae immunoglobulin A (IgA) antibodies were detected in 42(66.67%; 95% CI :55.03% to78.31%) cases (p
PCR for detection of C. pneumoniae was done on 40 cases, among which 13 (32.5%; 95% CI: 17.99% to 47.01%) of cases were positive for 16SrRNA gene of C. pneumoniae
Summary
Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Asian Indians are reported to have three times higher rates of incidence and prevalence of CAD when compared with western populations,[1,2] leading to a greater social and economic impact.[3,4] Various factors, such as metabolic syndrome, diabetes, dyslipidemia and possible genetic predisposition are believed to contribute to this rising epidemic in India. [1] The known risk factors of CAD are not sufficient to explain all the epidemiological variables and fluctuations of the disease. The hypothesis of infectious etiology of atherosclerosis is one of the most interesting areas of vascular research, it states that more than one infectious agent could play a role in atherogenesis and atherothrombosis This entire process may involve pro-inflammatory mechanisms like interleukins and cytokines.[5] Infectious agents are considered as significant factors in the pathogenesis of atherosclerosis because atherogenic processes resemble chronic inflammation-a process that may be promoted by microorganisms like Chlamydia pneumoniae (C. pneumoniae) and Cytomegalovirus (CMV).The hypothesis of infectious etiology is very attractive because it would provide us with a powerful platform for prevention and treatment of a disease which represents an escalating public health problem worldwide and even more so in India. Interferon- γ (IFN-γ) levels in serum were assessed for ongoing inflammatory activity by these microorganisms
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