Chlamydia pneumoniae-Mediated Inflammation in Atherosclerosis: A Meta-Analysis

Abstract

Several studies have attempted to relate the C. pneumoniae-mediated inflammatory state with atherosclerotic cardiovascular diseases, providing inconsistent results. Therefore, we performed a meta-analysis to clarify whether C. pneumoniae may contribute to the pathogenesis of atherosclerosis by enhancing inflammation. 12 case-control, 6 cross-sectional, and 7 prospective studies with a total of 10,176 patients have been included in this meta-analysis. Odds Ratio (OR) with a 95% confidence interval was used to assess the seroprevalence of C. pneumoniae and differences between levels of inflammatory markers were assessed by standard mean differences. Publication bias was performed to ensure the statistical power. hsCRP, fibrinogen, interleukin- (IL-) 6, TNF-α, and IFN-γ showed a significant increase in patients with atherosclerosis compared to healthy controls (P < 0.05), along with a higher seroprevalence of C. pneumoniae (OR of 3.11, 95% CI: 2.88-3.36, P < 0.001). More interestingly, hsCRP, IL-6, and fibrinogen levels were significantly higher in C. pneumoniae IgA seropositive compared to seronegative atherosclerotic patients (P < 0.0001). In conclusion, the present meta-analysis suggests that C. pneumoniae infection may contribute to atherosclerotic cardiovascular diseases by enhancing the inflammatory state, and, in particular, seropositivity to C. pneumoniae IgA, together with hsCRP, fibrinogen, and IL-6, may be predictive of atherosclerotic cardiovascular risk.

Figure 1

Forest plot of standardized mean differences (SMDs) of individual studies and pooled SMDs for hsCRP (a), IL-6 (b), and fibrinogen (c) in patients with atherosclerotic cardiovascular diseases and healthy controls.

Figure 2

Forest plot of standardized mean differences (SMDs) of individual studies and pooled SMDs for hsCRP (a), IL-6 (b), and fibrinogen (c) in C. pneumoniae IgG seropositive and seronegative patients with atherosclerotic cardiovascular diseases.

Figure 3

Forest plot of standardized mean differences (SMDs) of individual studies and pooled SMDs for hsCRP (a), IL-6 (b), and fibrinogen (c) in C. pneumoniae IgA seropositive and seronegative patients with atherosclerotic cardiovascular diseases.