Abstract
ObjectiveTo examine the association between helminth infections and atherosclerosis.BackgroundChronic helminth infection, which can lead to poor nutritional status and anti-inflammatory response, might protect against the development of atherosclerosis.MethodsA cross-sectional study was performed in Flores, Indonesia, an area highly endemic for soil-transmitted helminths (STH). Stool samples from 675 participants aged 18–80 years were collected and screened for Trichuris trichiura by microscopy and for Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, and Strongyloides stercoralis by qPCR. We collected data on body mass index (BMI), waist to hip ratio (WHR), blood pressure, fasting blood glucose (FBG), lipid, high sensitive C-reactive protein (hs-CRP), total immunoglobulin-E (TIgE) and Escherichia coli lipopolysaccharide stimulated cytokines (tumor necrosis factor and interleukin-10). In a subset of 301 elderly adults (≥40 years of age) carotid intima media thickness (cIMT) was measured.ResultsParticipants with any STH infection had lower BMI (kg/m2) (mean difference −0.66, 95%CI [−1.26, −0.06]), WHR (−0.01, [−0.02, −0.00]), total cholesterol (mmol/L) (−0.22, [−0.43, −0.01]) and LDL-cholesterol (mmol/L) (−0.20, [−0.39, −0.00]) than uninfected participants. After additional adjustment for BMI the association between helminth infection and total cholesterol (mean difference −0.17, 95%CI [−0.37, 0.03]) as well as LDL-cholesterol (−0.15, [−0.33, 0.04]) was less pronounced. BMI, WHR, and total cholesterol were negatively associated with number species of helminth co-infections. Participants with high TIgE, an indicator of exposure to helminths, had lower FBG, TC, and HDL. The association between TIgE and TC and HDL remained significant after adjustment with BMI. No clear association was found between STH infection or TIgE and mean cIMT.ConclusionsThis cross-sectional study presents evidence that helminth infections were negatively associated with risk factors for cardiovascular disease, an association at least partially mediated by an effect on BMI. The significance of this finding needs to be determined.
Highlights
Mortality from cardiovascular diseases (CVD) accounts for 30% of total global deaths [1]
This cross-sectional study presents evidence that helminth infections were negatively associated with risk factors for cardiovascular disease, an association at least partially mediated by an effect on body mass index (BMI)
The secondary objective was to study the association between helminth infections as well as total immunoglobulin E (TIgE), an indicator of exposure to helminths [17], and conventional CVD risk factors, including body mass index (BMI), waist hip ratio (WHR), blood pressure (BP), fasting blood glucose (FBG), serum lipid profile and serum markers of inflammation
Summary
Mortality from cardiovascular diseases (CVD) accounts for 30% of total global deaths [1]. CVD is no longer a disease of Western countries exclusively since 80% of all CVD deaths worldwide take place in developing countries. In many Asian countries, rapid socioeconomic development has led to a shift in infrastructure, technology and food supply that promotes over nutrition and sedentary lifestyle [2,3]. The relationship between a disturbed energy balance resulting from decreased physical activity or excess consumption of high-energy foods and CVD has long been acknowledged, but there is abundant evidence that inflammation plays a role in chronic noncommunicable diseases, including CVD. One particular modifier of the pathogenesis of CVD in non-western societies may be related to differences in infectious pressure between rural and urban societies. Chronic helminth infection, which can lead to poor nutritional status and anti-inflammatory response, might protect against the development of atherosclerosis
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