| Background: Coronary artery disease (CAD) is a common disease of cardiovascular system. It has been one of the main disease which hazards people all over the word. Although factors such as hypertension, diabetes mellitus, hypercholesterolemia, and smoking have been identified as important risk factors in the development of atherosclerosis, many patients with atherosclerosis lack traditional risk factors. This fact has stimulated the search for additional causal factors. One hypothetical mechanism that has been receiving increasing attention is that infection and inflammation may play roles in CAD. The evidence for chlamydia pneumoniae, cytomegalovirus, adenovirus, herpes simplex virus type-1, and helicobacter pylori as potential causative agents is strong, but whether the number of infectious pathogens to which an individual has been exposed (pathogen burden or infectious burden) may correlate with CAD is uncertain. It is emergent to understand further the primary causes and pathogenesis of CAD. Objective: to investigate the relationship between traditional CAD risk factors and CAD, between seropositivities and CAD, between levels of inflammation factorsand CAD, and the effect of total pathogen burden, systematic inflammation response on CAD.Methods: In a cohort of 164 individuals, IgG antibodies to chlamydia pneumoniae, cytomegalovirus, adenovirus, herpes simplex virus type-1, helicobacter pylori, and inflammation factors were determined. Moreover, the same cohort was evaluated for CAD on coronary angiography. An individual was defined as being CAD if there was any angiographical evidence of atherosclerosis, including plaque in any segment of the epicardial coronary tree (CAD group, 102 individuals). An individual was defined as being free of CAD only if all coronary arteries were judged to be angiographically smooth (control group, 62 individuals). In the patients with CAD the severity of coronary arteries atherosclerosis was evaluated on the modified scale of Gensini (coronary artery lesion score). In terms of clinical appearance, 49, 40, 13 individuals were diagnosed stable angina pectoris, unstable angina pectoris, and acute myocardial infarction in CAD group respectively. Results: Of the 164 individuals, 119 were male (72.6%), 45 were female (27.4%). Their ages ranged from 29 to 80 years (mean 62.6 and median 65). The ages of CAD group were paired with those of control group. Of the traditional CAD risk factors (male gender, hypertention, diabetes, hypercholesterolemia, smoking, and family history of CAD) , all but hypertention and smoking were significantly associated with the prevalence of CAD (PO.05). The prevalence of IgG antibodies directed against the pathogens in the 164 study patients were as follows: 131 for chlamydia pneumoniae (79.88%), 118 for cytomegalovirus (71.95%), 109 for adenovirus (66.64%), 137 for herpes simplex virus type-1 (83.54%), 72 for helicobacter pylori (42.07%). About 80% of the study subjects had been exposed to more than 3 of the 5 pathogens tested. Significant associations between the prevalence of CAD and seropositivities to the five pathogens tested were found by univariate analysis. The OR for chlamydia pneumoniae, cytomegalovirus, and helicobacter pylori as predictors of CAD were 4.35 (95%CI 1.52-12.47), 5.86 (95%CI 2.36-14.54), and 7.83 (95%CI 2.90-21.14) respectively. The percentage ofCAD for groups with pathogen burden divided into 0, 1, 2, 3, 4, 5 were 0, 33.3^ 23.K 28.9, 93.2N and 100 respectively. And the percentage of CAD for groups with pathogen burden divided into 0 to 2, 3 or 4, and 5 were 25, 60.7, and 100 respectively. The seropositivities were associated with an increasing prevalence of CAD (PO.05). In terms of clinical appearance, the risk of acute coronary syndrome in the groups with pathogen burden divided into 0 to 2, 3 or 4, and 5 were 0%, 25.8%, and 76.9% respectively (P<0.05). Total pathogen burden, levels of inflammation factors and coronary artery lesion score showed no significant difference between unstable angina pectoris individua... |
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