Published Online
on January 19, 2006

A more recent version of this article appeared on March 1, 2006

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Submitted on October 26, 2005
Accepted on November 21, 2005

Seropositivity to Chlamydia pneumoniae Is Associated With Risk of First Ischemic Stroke

Mitchell S.V. Elkind MD, MS^*; Maria Lucia C. Tondella PhD; Daniel R. Feikin MD, MSPH; Barry S. Fields PhD; Shunichi Homma MD; and Marco R. Di Tullio MD

From the Departments of Neurology (M.S.V.E.) and Medicine (S.H., M.R.DT.), College of Physicians and Surgeons, Columbia University, and the Columbia University Medical Center of New York-Presbyterian Hospital, New York, NY; Gertrude H. Sergievsky Center (M.S.V.E.), College of Physicians and Surgeons, Columbia University, New York, NY; and Respiratory Diseases Branch (M.L.C.T., D.R.F., B.S.F.), Centers for Disease Control and Prevention, Atlanta, Ga.

^* To whom correspondence should be addressed. E-mail: mse13{at}columbia.edu.

Background and Purpose--Serologic evidence of infection with Chlamydia pneumoniae has been associated with cardiovascular disease, but its relationship with stroke risk remains uncertain. The objective of this study is to determine whether serological evidence of C pneumoniae infection is associated with risk of ischemic stroke.

Methods--A population-based case-control study was performed in an urban, multiethnic population. Cases (n=246) had first ischemic stroke, and controls (n=474) matched for age, sex, and race-ethnicity were derived through random-digit dialing. Titers of C pneumoniae-specific IgG and IgA antibodies were measured using microimmunofluorescence, and positive titers were prospectively defined. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% CIs adjusting for medical, behavioral, and socioeconomic factors.

Results--Mean age among cases was 72.3±9.7 years; 50.8% were women. Elevated C pneumoniae IgA titers were associated with increased risk of ischemic stroke after adjusting for hypertension, diabetes mellitus, current cigarette use, atrial fibrillation, and levels of high-density lipoprotein and low-density lipoprotein (adjusted OR, 1.5; 95% CI, 1.0 to 2.2). Elevated IgG titers were not associated with stroke risk (adjusted OR, 1.2; 95% CI, 0.8 to 1.8). There was a trend toward an association of elevated IgA titers with atherosclerotic and lacunar stroke but less so cardioembolic or cryptogenic subtypes.

Conclusions--Serologic evidence of C pneumoniae infection is associated with ischemic stroke risk. IgA titers may be a better marker of risk than IgG. This association is independent of other stroke risk factors and is present for atherosclerotic, lacunar, and cardioembolic subypes. Further studies of the effect of C pneumoniae on stroke risk are warranted.

Key words: cerebrovascular disorders • Chlamydophila pneumoniae • risk factors • stroke, ischemic

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