Cytomegalovirus seropositivity and C-reactive protein have independent andcombined predictive value for mortality in patients with angiographically demonstrated coronary artery disease
Jb. Muhlestein et al., Cytomegalovirus seropositivity and C-reactive protein have independent andcombined predictive value for mortality in patients with angiographically demonstrated coronary artery disease, CIRCULATION, 102(16), 2000, pp. 1917-1923
Citations number
36
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-The role of inflammation in coronary artery disease (CAD) is bei
ng increasingly recognized. Markers of inflammation (eg, C-reactive protein
[CRP]) and infection (eg, seropositivity to Chlamydia pneumoniae, cytomega
lovirus [CMV], and Helicobacter pylori) have been proposed as risk factors
for CAD, but these associations require further evaluation.
Methods and Results-We prospectively tested whether CRP levels and IgG sero
positivity to C pneumoniae, CMV, and H pylori are predictors of subsequent
mortality in 985 consecutive patients with angiographically demonstrated CA
D (stenosis greater than or equal to 70%). Patients were followed for an av
erage of 2.7 years (range 1.5 to 4.0 years). Patients averaged 65 years of
age; 77% were men; and 110 (11.2%) died during follow-up. CRP levels were s
ignificantly elevated in nonsurvivors compared with survivors (mean CRP 3.1
mg/dL versus 1.5 mg/dL, P=0.003). After controlling for all known baseline
variables, the 2nd and 3rd tertiles of CRP compared with the 1st produced
a Cox hazard ratio (HR) for mortality of 2.4 (P=0.001), Of the 3 infectious
markers tested, only seropositivity to CMV (HR=1.9, P<0.05) was predictive
of mortality. The majority of mortality risk associated with elevated CRP
or CMV seropositivity occurred when both risk factors were present (P for t
rend <0.0001). Other independent predictors of increased risk of mortality
were age (HR=1.07 per year, P<0.0001), left ventricular ejection fraction (
HR=0.97 per percent, P<0.0001), and diabetes mellitus (HR=1.7, P=0.02).
Conclusions-CMV seropositivity and elevated CRP, especially when in combina
tion, are strong, independent predictors of mortality in patients with CAD.
This suggests an interesting hypothesis that a chronic, smoldering infecti
on (CMV) might have the capacity to accelerate the atherothrombotic process
.