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Chlamydia pneumoniae infection and cardiac risk factors in patients with myocardial infection.
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PMID:  22577429     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Evidences support the possible involvement of microorganisms such as Chlamydia pneumonia in the pathogenesis of ischemic heart diseases through a chronic inflammatory process. The aim of this study was to determine the relation between Chlamydia pneumoniae seropositivity with acute myocardial infarction and its related risk factors.
METHODS: In this case-control study, 88 patients admitted in CCU with a diagnosis of acute coronary syndrome, without a history of chronic diseases including cancers were selected as cases and 49 surgical patients without an evidence of cardiovascular disease according to clinical examinations and ECG were selected as controls. Demographic characteristics and background risk factors were obtained using a questionnaire by expert nurses. Venous blood sample was obtained from participants for measuring the anti Chlamydia IgG and IgM antibodies using ELISA method. The prevalence of antibodies was compared in both groups and its relation with coronary syndrome was evaluated.
RESULTS: 88 and 49 patients were enrolled in case and control groups, respectively. Mean age of patients and the controls was 14±59.7 and 13±56.9 years, respectively (P=0.26). Anti Chlamydia IgG seropositivity rate was 63(71.9%) and 23(46.9%) in case and controlcontrol groups, respectively (P<0.01; OR: 2.85; CI 95%: 1.38-5.9). Anti Chlamydia IgM was positive in 1 patient and 1 control. Anti Chlamydia IgG seropositivity rate was higher in patients older than 50 years old than those younger than 50 years old (OR: 2.83; CI 95%: 1.31 -1.14). There was a significant relation between BMI, smoking and Anti Chlamydia IgG seropositivity.
CONCLUSION: Considering the relation between anti Chlamydia antibody IgG seropositivity with BMI and myocardial infarction, it seems that appropriate diagnosis and treatment of these prone patients can be benefical.
Authors:
Zohreh Azarkar; Majid Jafarnejad; Mahmood Zaedast; Alireza Saadatjou; Parvaneh Portoghali
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  ARYA atherosclerosis     Volume:  6     ISSN:  2251-6638     ISO Abbreviation:  ARYA Atheroscler     Publication Date:  2011  
Date Detail:
Created Date:  2012-05-11     Completed Date:  2012-10-02     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101487337     Medline TA:  ARYA Atheroscler     Country:  Iran    
Other Details:
Languages:  eng     Pagination:  125-8     Citation Subset:  -    
Affiliation:
MD, Assistant Professor of Infectious Disease, Birjand University of Medical Sciences, Birjand, Iran.
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Journal Information
Journal ID (nlm-ta): ARYA Atheroscler
Journal ID (iso-abbrev): ARYA Atheroscler
Journal ID (publisher-id): ARYA
ISSN: 1735-3955
ISSN: 2251-6638
Publisher: Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences
Article Information
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© 2011 Isfahan Cardiovascular Research Center & Isfahan University of Medical Sciences
open-access:
Received Day: 13 Month: 2 Year: 2010
Accepted Day: 02 Month: 12 Year: 2010
Print publication date: Season: Winter Year: 2011
Volume: 6 Issue: 4
First Page: 125 Last Page: 128
ID: 3347834
PubMed Id: 22577429
Publisher Id: ARYA-6-125

Chlamydia Pneumoniae Infection and Cardiac Risk Factors in Patients with Myocardial Infection
Zohreh Azarkar(1)
Majid Jafarnejad(2)
Mahmood Zaedast(3)
Alireza Saadatjou(4)
Parvaneh Portoghali(5)
1MD, Assistant Professor of Infectious Disease, Birjand University of Medical Sciences, Birjand, Iran.
2MD, Associate Professor of Cardiology, Birjand University of Medical Sciences,Birjand, Iran.
3MD, Assistant Professor of clinical pathology, Birjand University of Medical Sciences, Birjand, Iran.
4MSs, Nursing, Birjand University of Medical Sciences, Birjand, Iran.
5BS, Nursing, Birjand University of Medical Sciences, Birjand, Iran.
Correspondence: Correspondence To: Zohreh Azarkar, Email: drz.azarkar@yahoo.com

Introduction

Atherosclerosis considered as the most important causes of mortality and morbidity worldwide. Various factors have been introduced in the pathology of atherosclerosis and acute myocardial infarction such as: defect in lipid metabolism, change in the concentration of various lipoproteins of cholesterol, genetic factors, diabetes, age, sex, and smoking habit. These factors are known to be involved directly or indirectly in atherosclerotic changes of arteries.1

Today, in addition to previously identified traditional risk factors, other factors are reported to play a role in atherosclerosis.2

Of these factors microorganisms such as Chlamydia pneumoniae, Cytomegalovirus, Helicobacter pylori, Streptococcus sanguis and Herpes type 1 and 2 can be noted. Microorganisms can invade the endothelium directly or indirectly and for example can cause endothelial damage by releasing endotoxins and lipopolysaccharides into the blood. On the other hand systemic responses to infections such as cytokine release can cause changes in lipid profile and make the endothelium prone to thrombosis and lead to formation of atherosclerotic plaque or thrombus.3, 4

Of these infections, infections such as Chlamydia pneumoniae which there is an effective antibiotic treatment for them are very important. Infections caused by Chlamydia pneumonia are considered to participate in inflammatory processes leading to coronary artery disease. After primary infection; the bacteria remain dormant intracellulary causing a chronic inflammatory stimulus.5 Recent seroepidemiologic findings in patients defected by coronary artery diseases have shown a relation between Chlamydia pneumoniae and atherosclerosis.6

In some studies a significant positive association was found between being overweight and IgG antibodies for Chlamydia pneumoniae.7

For the first time in thereigon, this study aimed to investigate the role of Chlamydia pneumoniae seropositivity with acute myocardial infarction and its related risk factors.


Materials and Methods

In this case-control study, 88 patients admitted in CCU with a diagnosis of acute coronary syndrome without a history of chronic diseases including cancers were selected as case group and 49 surgical patients (ENT patients, gynecology, hernia) without an evidence of cardiovascular disease according to clinical examinations and ECG were selected as control group.

Demographic characteristics and background risk factors were obtained using a questionnaire by expert nurses. Venous blood sample (5 cc) was obtained from all participants of two studied groups for measuring the anti Chlamydia IgG and IgM antibodies using ELISA method by MEDEC KIT.

Anti Chlamydia pneumoniae seropositivity rate was compared in case and control groups and its relation with coronary syndrome was evaluated.

Obtained data from case and control groups was analyzed by SPSS software and forward conditional logistic regression and chi-square statistical tests.


Results

In this study 88 and 49 patients were enrolled in case and control groups, respectively.Mean age of patients in case and control groups was 14±59.7 and 13±56.9 years, respectively (P=0.26). Other demographic characteristics and risk factors are presented in Table 1.

Anti Chlamydia IgG seropositivity rate was 63(71.9%) and 23(46.9%) in case and control groups, respectively (P<0.01; OR: 2.85; CI 95%: 1.38-5.9). In both groups, only one was positive for anti-Chlamydia IgM antibody. The anti Chlamydia IgG seropositivity rate was higher in patients older than 50 years old than those younger than 50 years old (OR: 2.83; CI 95%: 1.31-1.14).

The relation between anti Chlamydia IgG seropositivity and myocardial infarction and its related risk factors is presented in Table 2.


Discussion

In this study, we investigated the relation between both anti Chlamydia IgM and IgG seropositivity with myocardial infarction and its related risk factors. 71.6% and 1.1% of patients with acute coronary syndrome had positive anti chlamydia IgG and IgM antibodies, respectively. The anti Chlamydia IgG seropositivity rate was significantly higher in case group than control one and we concluded that there is a relation between anti Chlamydia IgG antibody and acute myocardial infarction.

Chlamydia pneumoniae is responsible for most of Chlamydia infections in human and 90% of Chlamydia pneumoniae infections are mild or asymptomatic. Total anti Chlamydia seropositivity rateis estimated to be 30% in middle-aged adults, worldwide.

Reports of prevalence of antibodies against this infection are relatively based on methods used for diagnosis such as microimmunofluorescence, compliment fixation, and enzyme immunoassay. Determination of the cut-off point and cross reaction with other species is also effective. IgM antibody is used for diagnosis of acute infection. IgG class antibody titer is lasts for a long duration and reduces slowly and indicates history of infection with an unknown duration. High titers of IgG are of diagnostic value for chronic infection.8

In recent years some studies have investigated possible role of Chlamydia pneumoniae in coronary artery diseases and controversial results has been reported. One of the important reasons is lacking a microimmunofluorescence standard and variability of acceptable cut-off titers of the test. Problems in description of Chlamydia serologic tests and variability of methods of antibody detection has led to different cut-off points in various studies, different methods of measurement and unique timing of sampling.9

Several studies have supported the role of Chlamydia pneumoniae in the initiation and continuationof atherosclerosis.914

Constant infection of Chlamydia pneumoniae in lungs and in atherosclerotic plaques is reported in some studies.15 Some studies did not support the mentioned relation between Chlamydia pneumoniae and atherosclerosis but majority of studies have reported that Chlamydia infection is involved in atherogenesis.9, 10, 16, 17

Epidemiologic studies reveal the propagation of Chlamydia infection around the world and majority of people are infected before age 20.18

In a study conducted on relation between Chlamydia pneumoniae and metabolic syndrome in Taiwan in 2009, there was a positive association between older age, smoking and Chlamydia specific antibody that was consistent with our study.19

In our study 70% of subjects younger than 50 and 77% of older than 55 years old subjects with acute myocardial infarction had been infected with Chlamydia pneumoniae. Also higher rate of anti Chlamydia IgG seropositivity in male patients in comparison with females in this study could explain the higher incidence of atherosclerotic diseases in male patients.

The relation between Chlamydia seropositivity and hyperlipidemia, diabetes and hypertension was reported in some previous studies19, but there was no significant relationship between mentioned factors and anti Chlamydia seropositivity in current study.

Our study showed a significant relationship between obesity and Chlamydia pneumonia which was consistent with some studies in this field.7, 20 Presence of atherosclerosis in patients without any typical risk factors and with positive Chlamydia pneumoniae infection can be related to these effects: direct effects of Chlamydia pneumoniae on endothelium and their growth in endothelial cells and direct effects of the microorganism in preparation of macrophages for absorption of oxidize LDL which is the first step of atherogenesis initiation. So, the presence of Chlamydia pneumoniae along with oxidative factors and oxidation can be possibly more important than hypercholesrolemia in the pathogenesis of atherosclerosis.5


Conclusion

In this study there was a significant relation between Chlamydia pneumonia seropositivity and acute myocardial infarction.Also, our study showed a significant relationship between obesity, older age, smoking and Chlamydia pneumoniae seropositivity.

For more conclusive findings in this field further investigation with larger sample size is recommended.Also considering the simplicity of treatment, we suggest that all angina pectoris patients, obese persons, old patients, and smokers that are at risk for acute ischemic accident should be evaluated and treated for this infection.


Acknowledgments

We are thankful to Valie Asr hospital's CCU personnel that kindly participated in this study and research deputy of Birjand University of Medical Sciences for supporting the project by a grant.

Conflict of Interests

Authors have no conflict of interests.


References
1. Leinonen M,Saikku P. Infections and atherosclerosisScand Cardiovasc JYear: 2000341122010816055
2. Kiechl S,Egger G,Mayr M,Wiedermann CJ,Bonora E,Oberhollenzer F,et al. Chronic infections and the risk of carotid atherosclerosis: prospective results from a large population studyCirculationYear: 2001103810647011222467
3. Fazio G,Giovino M,Gullotti A,Bacarella D,Novo G,Novo S. Atherosclerosis, inflammation and Chlamydia pneumoniaeWorld J CardiolYear: 200911314021160574
4. Franco RR,Bodanese LC,Repetto G,Piccoli JD,Wiehe M,Bonato C,et al. Inflammatory markers and antichlamydial antibodies in patients with metabolic syndromeArq Bras CardiolYear: 2010
5. Pesonen E,Tiirola T,Andsberg E,Jauhiainen M,Paldanius M,Persson K,et al. Serum chlamydial lipopolysaccharide as a prognostic factor for a new cardiovascular eventHeart LungYear: 20093831768119486785
6. Monno R,Fumarola L,Trerotoli P,Giannelli G,Correale M,Brunetti D,et al. Seroprevalence of Chlamydophila pneumoniae in ischaemic heart diseaseNew MicrobiolYear: 2010334381521213597
7. Thjodleifsson B,Olafsson I,Gislason D,Gislason T,Jogi R,Janson C. Infections and obesity: A multinational epidemiological studyScand J Infect DisYear: 2008405381617943636
8. Pesonen E,Andsberg E,Grubb A,Rautelin H,Meri S,Persson K,et al. Elevated infection parameters and infection symptoms predict an acute coronary eventTher Adv Cardiovasc DisYear: 2008264192419124438
9. Honarmand HR,Hajian M,Rahbar Taromsari M,Mirzajani E. Seroprevalence of Chlamydia pneumonia in patients with myocardial infarctionJournal of Semnan University of Medical SciencesYear: 200941026774
10. Pour Ahmad M. A study on the relationship between acute myocardial infarction and Chlamydia pneumoniaScientific Medical Journal of Ahwaz University of Medical SciencesYear: 20054514751
11. Rahimi B,Danesh Pajouh M,Ahsani S,Tahernia K. Cardiovascular disease and Chlamydia, Helicobacter pylori and cytomegalovirus infectionPejouhandeh Quarterly Research JournalYear: 20072463314
12. Spagnoli LG,Pucci S,Bonanno E,Cassone A,Sesti F,Ciervo A,et al. Persistent Chlamydia pneumoniae infection of cardiomyocytes is correlated with fatal myocardial infarctionAm J PatholYear: 20071701334217200180
13. Kosaka C,Hara K,Komiyama Y,Takahashi H. Possible role of chronic infection with Chlamydia pneumoniae in Japanese patients with acute myocardial infarctionJpn Circ JYear: 200064118192411110424
14. Liuba P,Pesonen E,Paakkari I,Batra S,Forslid A,Kovanen P,et al. Acute Chlamydia pneumoniae infection causes coronary endothelial dysfunction in pigsAtherosclerosisYear: 200316722152212818403
15. Stassen FR,Vainas T,Bruggeman CA. Infection and atherosclerosis. An alternative view on an outdated hypothesisPharmacol RepYear: 2008601859218276989
16. Hilden J,Lind I,Kolmos HJ,Als-Nielsen B,Damgaard M,Hansen JF,et al. Chlamydia pneumoniae IgG and IgA antibody titers and prognosis in patients with coronary heart disease: results from the CLARICOR trialDiagn Microbiol Infect DisYear: 20106643859220226329
17. Koh WP,Taylor MB,Chew SK,Phoon MC,Kang KL,Chow VT. Chlamydia pneumoniae IgG seropositivity and clinical history of ischemic heart disease in SingaporeJ Microbiol Immunol InfectYear: 20033631697414582560
18. Maia IL,Nicolau JC,Machado MN,Maia LN,Takakura IT,Rocha PR,et al. Prevalence of Chlamydia pneumoniae and Mycoplasma pneumoniae in different forms of coronary diseaseArq Bras CardiolYear: 20099264058, 43919629306
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20. Rantala A,Lajunen T,Juvonen R,Bloigu A,Paldanius M,Silvennoinen-Kassinen S,et al. Chlamydia pneumoniae infection is associated with elevated body mass index in young menEpidemiol InfectYear: 2010138912677320018131

Tables
[TableWrap ID: T0001] Table 1 

Demographic charactristics and risk factors in case and control groups


Variable Case Control P value

Number (%) Number (%)
Sex Female 21 (23.9) 26 (53.1) 0.001
Male 67 (76.1) 23 (46.9)
Age(y) ≤50 27 (30.7) 16 (32.7) 0.82
>50 61 (63.9) 33 (67.3)
BMI(kg/m2) <20 15 (17.1) 5 (10.2) 0.14
20-25 42 (47.7) 32 (65.3)
>25 31 (35.2) 12 (24.5)
Hypertention No 65 (73.9) 44 (89.8) 0.03
Yes 23 (26.1) 5 (10.2)
Diabetes No 78 (88.6) 47 (95.9) 0.15
Yes 10 (11.4) 2 (4.1)
Hyperlipidemi No 64 (72.7) 48 (98) <0.001
Yes 24 (27.3) 1 (2)
Smoking No 60 (68.2) 49 (100) <0.001
Yes 28 (31.8) 0 (0)
History of cold No 67 (76.1) 47 (95.9) 0.003
Yes 21 (23.9) 2 (4.1)

[TableWrap ID: T0002] Table 2 

The relation between positive anti chlamydia IgG and myocardial infarction and its related risk factors


Risk factors Number (%) Chlamydia pneumoniae OR (CI 95%) P value
Myocardial infarction No 49 (35.8) 23 (46.9) 1 0.005
Yes 88 (64.2) 63 (71.6) 2.85 (1.38-5.9)
Age ≤50 43 (31.4) 20 (46.5) 1 0.01
>50 94 (68.6) 66 (70.2) 2.83 (1.31-1.14)
BMI <20 20 (14.6) 9 (45) 1 0.03
20-25 74 (54) 47 (63.5) 3.57 (1.18-10.81)
>25 43 (31.4) 30 (69.8) 3.88 (1.2-12.56)
Smoking No 109 (79.6) 63 (57.8) 1 0.04
Yes 28 (20.4) 23 (82.1) 3.68 (1.08- 12.53)


Article Categories:
  • Original Article

Keywords: Acute myocardial infarction, Antibody, Chlamydia pneumoniae..

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