From the Departments of Thoracic Medicine (P.J.C., D.H.), Medicine
(G.Y.H.L., D.G.B.), and Microbiology (R.W.), City Hospital, Birmingham, and
School of Mathematics and Statistics, University of Birmingham (P.D.) (UK).
Correspondence to Dr P.J. Cook, Department of Medicine, Queen Elizabeth Medical Centre, Edgbaston, Birmingham B15, UK.
Background and Purpose—Several
studies have implied an association between Chlamydia
pneumoniae and atherosclerosis. Our research
was designed to investigate the association of this organism with
strokes and transient cerebral ischemia.
Methods—Antibodies to C pneumoniae were measured
in 176 patients with stroke or transient cerebral ischemia and
1518 control subjects with noncardiovascular,
nonpulmonary disorders. Acute infection or reinfection was
defined by IgG
Results—We found that 13.6% of stroke/transient ischemic
attack (TIA) patients and 5.7% of control subjects had antibody titers
suggesting acute C pneumoniae (re)infection, while
32.4% of stroke/TIA patients and 12.7% of control subjects had titers
suggesting previous infection (P<.05). Stroke/TIA
patients differed from control subjects in their levels of acute and
previous infection, with adjusted odds ratios of 4.2 (95% CI, 2.5 to
7.1) and 4.4 (95% CI, 3.0 to 6.5), respectively. These did not differ
notably between strokes resulting from major nonhemorrhagic infarcts,
small-vessel infarcts, or hemorrhage. Cholesterol,
triglyceride, fibrinogen, and von Willebrand factor
concentrations showed no apparent association with titers.
Conclusions—These data support the association of cerebral
vascular disease with previous C pneumoniae infection
and the association of stroke and transient cerebral ischemia
with recrudescence of infection.
© 1998 American Heart Association, Inc.
Original Contributions
Chlamydia pneumoniae Antibody Titers Are Significantly Associated With Acute Stroke and Transient Cerebral Ischemia
The West Birmingham Stroke Project
512 or IgM 8 or fourfold rise in IgG, and previous
infection was defined by IgG 64 to 256 or lgA 8. Logistic regression
was used to examine the influences of ethnic origin, age, sex, smoking
habit, diabetes mellitus, steroid medication, and social
deprivation on antibody levels. Some patients underwent CT
and carotid ultrasound examinations and cholesterol,
triglyceride, fibrinogen, and von Willebrand factor
estimations.
Key Words: cerebral ischemia, transient • infection • stroke, ischemic
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