Relationship between carotid intima media thickness and helminth infections on Flores Island, Indonesia

PLoS One. 2013;8(1):e54855. doi: 10.1371/journal.pone.0054855. Epub 2013 Jan 24.


Objective: To examine the association between helminth infections and atherosclerosis.

Background: Chronic helminth infection, which can lead to poor nutritional status and anti-inflammatory response, might protect against the development of atherosclerosis.

Methods: A cross-sectional study was performed in Flores, Indonesia, an area highly endemic for soil-transmitted helminths (STH). Stool samples from 675 participants aged 18-80 years were collected and screened for Trichuris trichiura by microscopy and for Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, and Strongyloides stercoralis by qPCR. We collected data on body mass index (BMI), waist to hip ratio (WHR), blood pressure, fasting blood glucose (FBG), lipid, high sensitive C-reactive protein (hs-CRP), total immunoglobulin-E (TIgE) and Escherichia coli lipopolysaccharide stimulated cytokines (tumor necrosis factor and interleukin-10). In a subset of 301 elderly adults (≥40 years of age) carotid intima media thickness (cIMT) was measured.

Results: Participants with any STH infection had lower BMI (kg/m2) (mean difference -0.66, 95%CI [-1.26, -0.06]), WHR (-0.01, [-0.02, -0.00]), total cholesterol (mmol/L) (-0.22, [-0.43, -0.01]) and LDL-cholesterol (mmol/L) (-0.20, [-0.39, -0.00]) than uninfected participants. After additional adjustment for BMI the association between helminth infection and total cholesterol (mean difference -0.17, 95%CI [-0.37, 0.03]) as well as LDL-cholesterol (-0.15, [-0.33, 0.04]) was less pronounced. BMI, WHR, and total cholesterol were negatively associated with number species of helminth co-infections. Participants with high TIgE, an indicator of exposure to helminths, had lower FBG, TC, and HDL. The association between TIgE and TC and HDL remained significant after adjustment with BMI. No clear association was found between STH infection or TIgE and mean cIMT.

Conclusions: This cross-sectional study presents evidence that helminth infections were negatively associated with risk factors for cardiovascular disease, an association at least partially mediated by an effect on BMI. The significance of this finding needs to be determined.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Atherosclerosis / blood
  • Atherosclerosis / parasitology
  • Atherosclerosis / pathology*
  • Body Composition
  • Body Mass Index
  • C-Reactive Protein / metabolism
  • Carotid Artery, Common / metabolism
  • Carotid Artery, Common / pathology*
  • Carotid Intima-Media Thickness*
  • Cholesterol, LDL / blood
  • Cross-Sectional Studies
  • Female
  • Helminthiasis / blood
  • Helminthiasis / parasitology
  • Helminthiasis / pathology*
  • Helminths / physiology
  • Humans
  • Indonesia
  • Interleukin-10 / blood
  • Islands
  • Male
  • Middle Aged
  • Risk Factors
  • Triglycerides / blood


  • Cholesterol, LDL
  • IL10 protein, human
  • Triglycerides
  • Interleukin-10
  • C-Reactive Protein

Grant support

This study was funded by The Royal Netherlands Academy of Arts and Science (KNAW), Ref.KNAW-05-PP-35, European Commission contracts INCO-CT-2006-031714 and INCO-CT-2006-032436, and the Prof. Dr. P.C. Flu Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.