Chlamydia pneumoniae seropositivity and risk of ischemic stroke: (original) (raw)

Abstract

Chlamydia pneumoniae has been linked with increased risk of cardiovascular disease, but data on stroke are sparse. We examined whether seropositivity to Chlamydia pneumoniae was associated with the risk of ischemic stroke in a nested case–control study. Data on Chlamydia pneumoniae serology, lifestyle factors, and medical history were obtained at baseline. Verified cases (n = 254) were compared with gender- and age-matched controls (n = 254). Positive IgA (≥ 1:16) or IgG (≥ 1:64) titers were associated with an increased risk of acute ischemic stroke, i.e. adjusted odds ratios (ORs) were 1.54 (95% confidence interval, CI: 0.96–2.47) and 1.28 (95% CI: 0.83–1.95). The adjusted OR was 1.77 (95% CI: 1.04–3.00) when both titers were elevated. The highest point estimates were seen for ischemic stroke due to large-artery atherosclerosis, adjusted OR: 6.32 (95% CI: 0.76–52.61) (IgG (≥ 1:64)). No clear associations were found for other types of ischemic stroke. The strength of the association varied depending on gender and the chosen cut-off values for the antibody titers. These results partly support the hypothesis that serologic evidence of Chlamydia pneumoniae infection may be associated with an increased risk of ischemic stroke. However, the risk may differ according to gender, subtype of ischemic stroke, and cut-off value of antibody titers.

Access this article

Log in via an institution

Subscribe and save

• Starting from 10 chapters or articles per month
• Access and download chapters and articles from more than 300k books and 2,500 journals
• Cancel anytime View plans

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

BMI:

body mass index

CI:

confidence interval

OR:

odds ratio

References

• R Ross (1999)ArticleTitleAtherosclerosis: An inflammatory disease.N Engl J Med 340 115–126Occurrence Handle10.1056/NEJM199901143400207Occurrence Handle1:STN:280:DyaK1M%2FptFSqtQ%3D%3DOccurrence Handle9887164
  Article CAS PubMed Google Scholar
• J Danesh R Collins R Peto (1997)ArticleTitleChronic infections and coronary heart disease: Is there a link?Lancet 350 430–436Occurrence Handle10.1016/S0140-6736(97)03079-1Occurrence Handle1:STN:280:ByiH3cnitVI%3DOccurrence Handle9259669
  Article CAS PubMed Google Scholar
• J Ngeh V Anand S Gupta (2002)ArticleTitleChlamydia pneumoniae and atherosclerosis–what we know and what we don’t.Clin Microbiol Infect 8 2–13Occurrence Handle10.1046/j.1469-0691.2002.00382.x
  Article Google Scholar
• J Danesh P Whincup M Walker_et al._ (2000)ArticleTitleChlamydia pneumoniae IgG titres and coronary heart disease: Prospective study and meta-analysis.Br Med J 321 208–213
  Google Scholar
• ML Wimmer R Sandmann-Strupp P Saikku RL Haberl (1996)ArticleTitleAssociation of chlamydial infection with cerebrovascular disease.Stroke 27 2207–2210
  Google Scholar
• PJ Cook D Honeybourne GYH Lip DG Beevers R Wise P Davies (1998)ArticleTitleChlamydia pneumoniae antibody titers are significantly associated with acute stroke and transient cerebral ischemia.Stroke 29 404–410
  Google Scholar
• B Fagerberg J Gnarpe H Gnarpe S Agewall J Wikstrand (1999)ArticleTitleChlamydia pneumoniae but not cytomegalovirus antibodies are associated with future risk of stroke and cardiovascular disease.Stroke 30 299–305
  Google Scholar
• MSV Elkind I-F Lin JT Grayston RL Sacco (2000)ArticleTitleChlamydia pneumoniae and the risk of first ischemic stroke.Stroke 31 1521–1525
  Google Scholar
• SC Wolf O Mayer S Jurgens_et al._ (2003)ArticleTitleChlamydia pneumoniae IgA seropositivity is associated with increased risk for atherosclerotic vascular disease, myocardial infarction and stroke in dialysis patients.Clin Nephrol 59 273–279
  Google Scholar
• JG Madre JL Garcia RC Gonzalez_et al._ (2002)ArticleTitleAssociation between seropositivity to Chlamydia pneumoniae and acute ischaemic stroke.Eur J Neurol 9 303–306Occurrence Handle10.1046/j.1468-1331.2002.00408.x
  Article Google Scholar
• CA Glader B Stegmayr J Boman_et al._ (1999)ArticleTitleChlamydia pneumoniae antibodies and high lipoprotein(a) levels do not predict ischemic cerebral infarctions.Stroke 30 2013–2018
  Google Scholar
• PU Heuschmann D Neureiter M Gesslein_et al._ (2001)ArticleTitleAssociation between infection with Helicobacter pylori and Chlamydia pneumoniae and risk of ischemic stroke subtypes.Stroke 32 2253–2258
  Google Scholar
• J Ngeh S Gupta C Goodbourn B Panayiotou G McElligott (2003)ArticleTitleChlamydia pneumoniae in elderly patients with stroke (C-PEPS)): A case–control study on the seroprevalence of Chlamydia pneumoniae in elderly patients with acute cerebrovascular disease.Cerebrovasc Dis 15 11–16Occurrence Handle10.1159/000067115
  Article Google Scholar
• SL Melnick E Shahar AR Folsom_et al._ (1993)ArticleTitlePast infection by Chlamydia pneumoniae strain TWAR and asymptomatic carotid atherosclerosis.Am J Med 95 499–504Occurrence Handle10.1016/0002-9343(93)90332-J
  Article Google Scholar
• JT Grayston CC Kuo AS Coulson_et al._ (1995)ArticleTitleChlamydia pneumoniae (TWAR) in atherosclerosis of the carotid artery.Circulation 92 3397–3400
  Google Scholar
• C Schmidt J Hulthe J Wikstrand_et al._ (2000)ArticleTitleChlamydia pneumoniae seropositivity is associated with carotid artery intima-media thickness.Stroke 31 1526–1531
  Google Scholar
• D Sander K Winbeck J Klingelhofer T Etgen B Conrad (2001)ArticleTitleEnhanced progression of early carotid atherosclerosis is related to Chlamydia pneumoniae (Taiwan Acute Respiratory) seropositivity.Circulation 103 1390–1395
  Google Scholar
• R LaBiche D Koziol TC Quinn_et al._ (2001)ArticleTitlePresence of Chlamydia pneumoniae in human symptomatic and asymptomatic carotid atherosclerotic plaque.Stroke 32 855–860
  Google Scholar
• D Virok Z Kis L Karai_et al._ (2001)ArticleTitleChlamydia pneumoniae in atherosclerotic middle cerebral artery.Stroke 32 1973–1978
  Google Scholar
• M Prager Z Turel WS Speidl_et al._ (2002)ArticleTitleChlamydia pneumoniae in carotid artery atherosclerosis.Stroke 33 2756–2761Occurrence Handle10.1161/01.STR.0000039322.66575.77
  Article Google Scholar
• HS Markus M Sitzer D Carrington MA Mendall H Steinmetz (1999)ArticleTitleChlamydia pneumoniae infection and early asymptomatic carotid atherosclerosis.Circulation 100 832–837
  Google Scholar
• KA Coles AJ Plant TV Riley DW Smith BM McQuillan PL Thompson (1999)ArticleTitleLack of association between seropositivity to Chlamydia pneumoniae and carotid atherosclerosis.Am J Cardiol 84 825–828Occurrence Handle10.1016/S0002-9149(99)00445-2
  Article Google Scholar
• A Tjønneland K Overvad (2000)ArticleTitleDiet, cancer and health–a prospective cohort study and biological bank in Denmark (In Danish).Ugeskr Laeger 162 350–354
  Google Scholar
• TF Andersen M Madsen J Jorgensen L Mellemkjoer JH Olsen (1999)ArticleTitleThe Danish National Hospital Register.Dan Med Bull 46 263–268Occurrence Handle1:STN:280:DyaK1MzltVyrtw%3D%3DOccurrence Handle10421985
  CAS PubMed Google Scholar
• SP Johnsen K Overvad HT Sorensen A Tjonneland SE Husted (2002)ArticleTitlePredictive value of stroke and transient ischemic attack discharge diagnoses in The Danish National Registry of Patients.J Clin Epidemiol 55 602–607Occurrence Handle10.1016/S0895-4356(02)00391-8
  Article Google Scholar
• National Institute of Neurological Disorders and Stroke Ad Hoc Committee. Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases. III. Stroke 1990; 21: 637-676.
• HP Adams Jr BH Bendixen LJ Kappelle_et al._ (1993)ArticleTitleClassification of subtype of acute ischemic stroke.Definitions for use in a multicenter clinical trial. Stroke 24 35–41
  Google Scholar
• S Wacholder JK McLaughlin DT Silverman JS Mandel (1992)ArticleTitleSelection of controls in case–control studies, I: Principles.Am J Epidemiol 135 1019–1028
  Google Scholar
• K Persson J Boman (2000)ArticleTitleComparison of five serologic tests for diagnosis of acute infections by C.pneumoniae. Clin Diagn Lab Immunol 7 739–744Occurrence Handle10.1128/CDLI.7.5.739-744.2000
  Article Google Scholar
• FJ Nieto AR Folsom PD Sorlie JT Grayston SP Wang LE Chambless (1999)ArticleTitleChlamydia pneumoniae infection and incident coronary heart disease: The Atherosclerosis Risk in Communities Study.Am J Epidemiol 150 149–156
  Google Scholar
• J Boman MR Hammerschlag (2002)ArticleTitleChlamydia pneumoniae and atherosclerosis: Critical assessment of diagnostic methods and relevance to treatment studies.Clin Microbiol Rev 15 1–20
  Google Scholar
• SE Epstein J Zhu (1999)ArticleTitleLack of association of infectious agents with risk of future myocardial infarction and stroke.Definitive evidence disproving the infection/coronary artery disease hypothesis? Circulation 100 1366–1368
  Google Scholar
• DS Siscovick SM Schwartz M Caps SP Wang JT Grayston (2000)ArticleTitleChlamydia pneumoniae and atherosclerotic risk in populations: The role of seroepidemiology.J Infect Dis. 181(Suppl 3) S417–S420Occurrence Handle10.1086/315623
  Article Google Scholar
• A Paganini-Hill E Lozano G Fischberg_et al._ (2003)ArticleTitleInfection and risk of ischemic stroke.Stroke 34 452–457Occurrence Handle10.1161/01.STR.0000053451.28410.98
  Article Google Scholar

Download references

Author information

Authors and Affiliations

1. Department of Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aarhus, Denmark
   Søren P. Johnsen & Henrik T. Sørensen
2. Department of Epidemiology and Social Medicine, Aarhus University, Aarhus, Denmark
   Kim Overvad
3. Research Unit Q, Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
   Lars Østergaard
4. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
   Anne Tjønneland
5. Department of Cardiology and Internal Medicine, Aarhus County Hospital, Aarhus University Hospital, Copenhagen, Denmark
   Steen E. Husted

Authors

1. Søren P. Johnsen
2. Kim Overvad
3. Lars Østergaard
4. Anne Tjønneland
5. Steen E. Husted
6. Henrik T. Sørensen

Corresponding author

Correspondence toSøren P. Johnsen.

Rights and permissions

About this article

Cite this article

Johnsen, S.P., Overvad, K., Østergaard, L. et al. Chlamydia pneumoniae seropositivity and risk of ischemic stroke:.Eur J Epidemiol 20, 59–65 (2005). https://doi.org/10.1007/s10654-004-4341-5

Download citation

• Accepted: 11 March 2004
• Issue date: January 2005
• DOI: https://doi.org/10.1007/s10654-004-4341-5

Keywords