CONFIRMED PREVIOUS INFECTION WITH CHLAMYDIA-PNEUMONIAE (TWAR) AND ITSPRESENCE IN EARLY CORONARY ATHEROSCLEROSIS

Background-Chlamydia pneumoniae has been identified in coronary athero ma, but concomitant serum antibody titers have been inconsistently pos itive and unavailable before the detection of early or advanced athero sclerotic lesions. Methods and Results-This retrospective investigatio n was performed on premortem serum specimens and autopsy tissue from 6 0 indigenous Alaska Natives at low risk for coronary heart disease, se lected by the potential availability of their stored specimens. Serum specimens were drawn a mean of 8.8 years (range, 0.7 to 26.2 years) be fore death, which occurred at a mean age of 34.1 years (range, 15 to 5 7 years), primarily from noncardiovascular causes (97%). Coronary arte ry tissues were independently examined histologically and, for C pneum oniae organism and DNA, by immunocytochemistry (ICC) and polymerase ch ain reaction (PCR) with species-specific monoclonal antibody and prime rs. Microimmunofluorescence detected species-specific IgG, IgA, and Ig M antibody in stored serum. C pneumoniae, frequently within macrophage foam cells, was identified in coronary fibrolipid atheroma (raised le sions, Stary types II through V) in 15 subjects (25%) and early flat l esions in 7 (11%) either by PCR (14, 23%) or ICC (20, 33%). The OR for C pneumoniae in raised atheroma after a level of IgG antibody greater than or equal to 1:256 >8 years earlier was 6.1 (95% CI, 1.1 to 36.6) and for all coronary tissues after adjustment for multiple potential confounding variables, including tobacco exposure, was 9.4 (95% CI, 2. 6 to 33.8). Conclusions-Serological evidence for C pneumoniae infectio n frequently precedes both the earliest and more advanced lesions of c oronary atherosclerosis that harbor this intracellular pathogen, sugge sting a chronic infection and developmental role in coronary heart dis ease.