B. Chiu et al., CHLAMYDIA-PNEUMONIAE, CYTOMEGALOVIRUS, AND HERPES-SIMPLEX VIRUS IN ATHEROSCLEROSIS OF THE CAROTID-ARTERY, Circulation, 96(7), 1997, pp. 2144-2148
Background Chlamydia pneumoniae and the herpes viruses cytomegalovirus
(CMV) and herpes simplex virus type 1 (HSV-1) have been associated wi
th human atherosclerosis in seroepidemiological and separate histopath
ological studies. We investigated the concurrent presence of these mic
roorganisms in patients undergoing carotid endarterectomy. Methods and
Results Endarterectomy specimens from 76 patients with carotid artery
stenosis were stained for C pneumoniae, CMV, and HSV-1 particles with
specific IgG monoclonal antibodies by the avidin-biotin-peroxidase me
thod. IgG antibodies to CMV and C pneumoniae were also measured in the
serum. These were correlated with plaque morphology and the presence
of the microorganisms in the atherosclerotic plaques. C pneumoniae was
detected in 54 (71%) (95% confidence interval [CI], 59.5% to 80.9%),
CMV was detected in 27 (35.5%) (CI, 24.9% to 47.3%), and HSV-1 was det
ected in 8 (10.5%) (CI, 4.7% to 19.7%) versus none of 20 (0%) control
normal carotid artery and aortic tissue (autopsy) specimens (CI, 0% to
16.8%) (P < .001 for CMV and C pneumoniae). At least one microorganis
m was detected in 59 of the specimens (77.6%) (CI, 66.6% to 86.4%), wi
th a single microorganism present only in 35 (46%), two microorganisms
present in 18 (23.7%) (CI, 14.7% to 34.8%), and all three present inp
(7.9%) (CI, 3.0% to 16.4%). Atherosclerotic plaques with thrombosis w
ere more likely to have C pneumoniae (80.4%) or CMV (57.8%) than were
plaques without thrombosis (56.7% and 16.7%, respectively; P = .04 and
.007). There was no correlation between the presence of CMV and C pne
umoniae in the atherosclerotic vessels and serum antibody titers. Conc
lusions C pneumoniae and CMV are commonly detected in atherosclerotic
plaques of the carotid arteries, but their presence cannot be predicte
d by measuring serum antibodies. The presence of these microorganisms
may predispose to a greater risk of thrombosis in the plaques, but fur
ther studies are needed to confirm this observation.