Individual pathogens, pathogen burden and markers of subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis

J Cardiovasc Med (Hagerstown). 2009 Oct;10(10):747-51. doi: 10.2459/JCM.0b013e32832cacab.


Methods: We examined the cross-sectional relationships of subclinical atherosclerosis - expressed by carotid intimal-medial thickness and coronary calcification - with antibodies to Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, herpes simplex virus, hepatitis A virus, and pathogen burden (number of positive pathogens). A random sample of 1056 individuals chosen from 5030 Multi-Ethnic Study of Atherosclerosis cohort participants were included.

Results: After multiple adjustment, no associations were found between atherosclerosis measures and either individual pathogens or pathogen burden. Interactions with inflammatory and endothelial function markers, demographic factors, BMI, high-density lipoprotein, diabetes, and smoking were also explored. The only interaction that was large, qualitative, statistically significant (P < 0.05) and in the expected direction was that between hepatitis A virus and soluble intercellular adhesion molecule-1 with regard to Agatston calcium score: the difference between hepatitis A virus-positive and hepatitis A virus-negative participants was -186 units in participants with soluble intercellular adhesion molecule-1 below the median, and +162 units in those with soluble intercellular adhesion molecule-1 equal or above the median. However, given the number of interactions that were explored, these results must be interpreted cautiously.

Conclusion: Findings from the present analyses do not provide support for an infectious etiology for subclinical atherosclerosis. However, the study's limitations, which include its cross-sectional design and insufficient statistical power, suggest that inferences from its findings should be made cautiously.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Antibodies, Bacterial / blood
  • Antibodies, Viral / blood
  • Atherosclerosis / epidemiology*
  • Atherosclerosis / microbiology
  • Calcium / analysis
  • Carotid Arteries / chemistry
  • Chlamydophila Infections / epidemiology*
  • Chlamydophila pneumoniae / isolation & purification
  • Coronary Vessels / chemistry
  • Cross-Sectional Studies
  • Cytomegalovirus Infections / epidemiology*
  • Endothelium, Vascular / physiopathology
  • Ethnic Groups / statistics & numerical data
  • Female
  • Helicobacter Infections / epidemiology*
  • Helicobacter pylori / isolation & purification
  • Herpes Simplex / epidemiology*
  • Herpesvirus 1, Human / isolation & purification
  • Humans
  • Male
  • Middle Aged
  • Seroepidemiologic Studies
  • United States / epidemiology
  • Viral Load


  • Antibodies, Bacterial
  • Antibodies, Viral
  • Calcium