BMJ 2000;321:208-213 ( 22 July )

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Chlamydia pneumoniae IgG titres and coronary heart disease: prospective study and meta-analysis

Editorial by Koenig

John Danesh, clinical research fellow, ^a Peter Whincup, professor, ^b Mary Walker, senior lecturer, ^c Lucy Lennon, research assistant, ^c Andrew Thomson, computer programmer, ^c Paul Appleby, statistician, ^d Yuk-ki Wong, research registrar, ^e Martine Bernardes-Silva, research scientist, ^e Michael Ward, professor. ^e

^a Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford OX2 6HE, ^b Department of Public Health Sciences, St George's Hospital Medical School, London SW17 ORE, ^c Department of Population Sciences and Primary Care, Royal Free and University College London Medical School, London NW3 2PF, ^d Imperial Cancer Research Fund Cancer Epidemiology Unit, Oxford OX2 6HE, ^e Departments of Cardiology and Molecular Microbiology, University of Southampton, Southampton SO16 6YD

Correspondence to: J Danesh

Objective: To examine the association between coronary heart disease and serum markers of chronic Chlamydia pneumoniae infection.
Design: "Nested" case-control analysis in a prospective cohort study and an updated meta-analysis of previous relevant studies.
Setting: General practices in 18 towns in Britain.
Participants: Of the 5661 men aged 40-59 who provided blood samples during 1978-80, 496 men who died from coronary heart disease or had non-fatal myocardial infarction and 989 men who had not developed coronary heart disease by 1996 were included.
Main outcome measures: IgG serum antibodies to C pneumoniae in baseline samples; details of fatal and non-fatal coronary heart disease from medical records and death certificates.
Results: 200 (40%) of the 496 men with coronary heart disease were in the top third of C pneumoniae titres compared with 329 (33%) of the 989 controls. The corresponding odds ratio for coronary heart disease was 1.66 (95% confidence interval 1.25 to 2.21), which fell to 1.22 (0.82 to 1.82) after adjustment for smoking and indicators of socioeconomic status. No strong associations were observed between C pneumoniae IgG titres and blood lipid concentrations, blood pressure, or plasma homocysteine concentration. In aggregate, the present study and 14 other prospective studies of C pneumoniae IgG titres included 3169 cases, yielding a combined odds ratio of 1.15 (0.97 to 1.36), with no significant heterogeneity among the separate studies (²=10.5, df=14; P>0.1).
Conclusion: This study, together with a meta-analysis of previous prospective studies, reliably excludes the existence of any strong association between C pneumoniae IgG titres and incident coronary heart disease. Further studies are required, however, to confirm or refute any modest association that may exist, particularly at younger ages.

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A good answer, but what was the question?

Adam Jacobs
bmj.com, 29 Jul 2000 [Full text]

Re: A good answer, but what was the question?

Philip Stowell
bmj.com, 7 Aug 2000 [Full text]

what is the evidence for antibiotic therapy in atherosclerosis?

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consider ethnic variations

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