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Elevated infection parameters and infection symptoms predict an acute coronary event

Department of Pediatric Cardiology, University Hospital, Lund, Sweden, erkki.pesonen{at}med.lu.se

Eva Andsberg

Department of Pediatric Cardiology, University Hospital, Lund, Sweden. erkki.pesonen{at}med.lu.se

Anders Grubb

Department of Clinical Chemistry, University Hospital, Lund, Sweden

Hilpi Rautelin

Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki and Helsinki University Central Hospital Laboratory, Helsinki, Finland

Seppo Meri

Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki and Helsinki University Central Hospital Laboratory, Helsinki, Finland

Kenneth Persson

Department of Microbiology, University Hospital, Lund, Sweden

Mirja Puolakkainen

Helsinki University Central Hospital Laboratory and Department of Virology, Haartman Institute, University of Helsinki, Helsinki, Finland

Seppo Sarna

Department of Public Health, Helsinki University, Helsinki, Finland

Hans Öhlin

Department of Cardiology, University Hospital, Lund, Sweden

Background: The etiology and significance of flu-like symptoms often appearing before myocardial infarction should be clarified.

Methods: In a case-control study of 323 matched controls and a random sample of 110 out of 351 cases the presence of infection symptoms during the preceding four weeks before admission were asked and blood samples taken.

Results: Enterovirus (EV), herpes simplex virus (HSV), and Chlamydia pneumoniae IgA titers were significantly higher in cases than in controls (p<0.001, 0.008 and 0.046, respectively). Flu-like symptoms appeared significantly more often in patients than in controls the most common one being fatigue (p<0.001). In controls with fatigue, EV and HSV titers showed a trend to be higher (1.50 vs 1.45 and 4.29 vs 3.73) than in controls without fatigue but only HSV titers were statistically significantly higher (3.47 vs 3.96, p = 0.02). Even CRP and amyloid A concentrations (3.49 vs 2.08, p<0.0001 and 5.70 vs 3.77 mg/l, p = 0.003, respectively) as well as C4 (0.40 vs 0.44, p = 0.02) were higher in controls with fatigue.

Conclusions: Odds ratios for a coronary event in a logistic regression model were 4.79 for fatigue and 2.72 for EV antibody levels in their fourth quartile. A linear-by-linear association test showed increasing number of single symptoms with higher EV titer quartiles (p = 0.004).

Key Words: atherosclerosis • epidemiology • infarction • inflammation

Therapeutic Advances in Cardiovascular Disease, Vol. 2, No. 6, 419-424 (2008)
DOI: 10.1177/1753944708098695


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