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Mundkur L.A.,Thrombosis Research Institute | Shivanandan H.,Thrombosis Research Institute | Hebbagudi S.,Thrombosis Research Institute | Endresz V.,University of Szeged | And 5 more authors.
Heart | Year: 2012

Background: Several studies have reported a conflicting association between cytomegalovirus (CMV) infection and coronary artery disease (CAD) based on the levels of total anti-CMV antibodies. However, none have estimated the levels of specific neutralising antibodies (NA) to CMV, which may be clinically more relevant. Objective: To determine whether CMV-NA titres show a better association with CAD compared with total anti- CMV antibody levels. Design: CMV-NA titres were measured by microneutralisation assay and anti-CMV IgG antibodies using ELISA in 391 consecutive CAD patients compared with the same number of controls (N=782), and 91 patients reporting recurrent cardiac events during a 4-year follow-up compared with those without a recurrent event (N=182). Levels of inflammatory markers, interleukin 6, high-sensitivity C reactive protein, fibrinogen and secretory phospholipase A2 (sPLA2), were measured by ELISA. Analysis of variance and logistic regression were used for statistical analyses. Results: High CMV-NA titres showed a positive association with CAD occurrence (OR 2.24, 95% CI 1.31 to 3.85, p=0.003) and recurrent cardiac events in CAD patients (OR 4.65, 95% CI 1.21 to 17.86, p=0.025) compared with total CMV antibodies (OR 1.67, 95% CI 1.04 to 2.69, p=0.034, and 2.70, 1.04 to 7.02, p=0.040, respectively). Patients with higher quartile of CMV-NA titres and sPLA2 levels had an adjusted OR of 7.82 (95% CI 1.87 to 32.65, 0.005) for recurrent cardiac events compared with those with the lowest quartiles for both markers. Conclusion: These findings suggest that high CMV-NA titres in combination with inflammatory markers improve prediction of cardiac events in the Asian Indian population.

Mundkur L.A.,Thrombosis Research Institute Bangalore | Rao V.S.,Thrombosis Research Institute Bangalore | Hebbagudi S.,Thrombosis Research Institute Bangalore | Shanker J.,Thrombosis Research Institute Bangalore | And 4 more authors.
Experimental and Clinical Cardiology | Year: 2012

BACKGROUND: Coronary artery disease (CAD) occurs at an earlier age in South Asians compared with other ethnic groups. Infection and inflammation show a positive association with the disease. OBJECTIVE: To investigate the association of infection and inflammatory markers with premature CAD in the Indian Atherosclerosis Research Study population. METHODS: Antibody titres for Chlamydia pneumoniae, cytomegalovirus (CMV), Helicobacter pylori, herpes simplex virus and levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), fibrinogen and secretory phospholipase A2, were measured in 866 individuals (433 CAD patients and matched controls). All individuals were followed-up for recurrent cardiac events for four years. ANOVA was used to study the association of infection and inflammation with CAD. RESULTS: The present study found that the odds of CAD occurrence was 2.42 (95% CI 1.26 to 4.64; P<0.008), with all four infections and increased in the presence of hsCRP (OR 4.67 [95% CI 1.43 to 15.25]); P=0.011). Only anti-CMV antibody levels were a significant risk factor for CAD occurrence (OR 2.23 [95% CI 1.20 to 4.15]; P=0.011) and recurrent cardiac events (OR 1.94 [95% CI 0.85 to 4.45]; P=0.015). Mean values of the inflammatory biomarkers IL-6 (P=0.035), fibrinogen (P=0.014), hsCRP (P=0.010) and secretory phospholipase A2 (P=0.002) increased with CMV antibody levels. Incorporating hsCRP and IL-6 in the risk prediction models significantly increased the OR to 2.56 (95% CI 1.16 to 5.63; P=0.019) with a c statistic of 0.826. CONCLUSIONS: Pathogen burden, especially CMV infection in combination with inflammatory markers, is a significant predictor of CAD risk in the young Indian population. ©2012 Pulsus Group Inc. All rights reserved.

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