Infectious risk factors for atherosclerotic vascular disease in hemodialysis patients -: Chlamydia pneumoniae but not Helicobacter pylori or cytomegalovirus is associated with increased C-reactive protein

Background: Cardiovascular disease is a major problem in patients with chronic renal failure leading to increased mortality. Several infectious agents have been implicated to be associated with atherosclerosis. We were interested to evaluate whether there is a correlation between a past infection with Chlamydia pneumoniae (Cpn), Helicobacter pylori (Hp) or cytornegalovirus (CMV) and the manifestation of a symptomatic atherosclerotic disease in patients with endstage renal failure. Methods and Results: Patients (n = 267) on hemodialysis were investigated. In 101 patients with an apparent atherosclerotic disease (case group) increased IgA levels against Cpn were found (pless than or equal to0.0001 vs. controls; n=33). Nearly 45% of the case group had a history of myocardial infarction (MI) (pless than or equal to0.0001). Prior stroke was found in about 30% of patients in the case group (pless than or equal to0.002). Elevated CRP levels were identified as an independent risk factor for atherosclerosis in all groups. IgA seropositivity against Cpn correlated with elevated CRP values for all atherosclerotic patients (pless than or equal to0.001), especially in the group of patients with MI (pless than or equal to0.019) and peripheral vascular disease (pless than or equal to0.005). There was no correlation between CMV (IgG, IgM) or Hp (IgA, IgG) seropositivity and atherosclerotic disease. Conclusion: IgA seropositivity for Cpn and elevated CRP values but not Hp or CMV was associated with an increased rate of symptomatic atherosclerotic manifestations as MI, stroke, cerebral or peripheral atherosclerosis in patients with endstage renal disease on hemodialysis.