Smieja M, Gnarpe J, Lonn E, Gnarpe H, Olsson G, Yi Q et al; Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Circulation 2003;107:257.
Comment in:
Circulation 2003;107:220-222.
Circulation 2003;108:e8.

BACKGROUND: Limited prospective epidemiological data are available on the relation between exposure to Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus (CMV), and hepatitis A virus (HAV), individually or as a total pathogen score, and human cardiovascular (CV) disease. METHODS AND RESULTS: We analyzed enrollment sera from 3168 Canadian patients in the Heart Outcomes Prevention Evaluation (HOPE) study for antibodies to C. pneumoniae, H. pylori, CMV and HAV and measured the relation between serostatus and 494 adjudicated trial outcomes of myocardial infarction, stroke or CV death over 4.5 years of follow-up. CV events were associated with CMV serostatus (covariate-adjusted hazard ratio [HR], 1.24; 95% CI, 1.01, 1.53). Neither C. pneumoniae IgG (adjusted HR, 0.87; 95% CI, 0.68, 1.10), C. pneumonia IgA (adjusted HR, 1.10; 95% CI, 0.90, 1.34), H. pylori IgG (HR, 0.99; 95% CI, 0.82, 1.19), nor HAV IgG (HR, 1.01; 95% CI, 0.83, 1.24) predicted CV events. Total pathogen score was associated with CV events (adjusted HR for 4 versus 1 or 0=1.41; 95% CI, 1.02, 1.96).
CONCLUSIONS: Exposure to CMV but not to C. pneumoniae, H. pylori, or HAV was associated with a slight excess risk of subsequent myocardial infarction, stroke or CV death in HOPE study patients, and total pathogen score based on these infections predicted a small increased hazard of CV events.