(Stroke. 2000;31:1521.)
© 2000 American Heart Association, Inc.
Original Contributions |
Chlamydia pneumoniae and the Risk of First Ischemic Stroke
The Northern Manhattan Stroke Study
Presented in part in abstract form at the European Stroke Conference, Edinburgh, Scotland, May 1998, and published in abstract form (Cerebrovasc Dis. 1998;8[suppl 4]:4).
From the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Columbia-Presbyterian Medical Center of New York Presbyterian Hospital, New York, NY (M.S.V.E., R.L.S.); the Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY (M.S.V.E., R.L.S.); the Division of Biostatistics, Joseph P. Mailman School of Public Health, Columbia University, New York, NY (I.-F.L.); the Departments of Epidemiology and Pathobiology, School of Public Health and Community Medicine, University of Washington, Seattle (J.T.G.); and the Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY (R.L.S.).
Correspondence to Mitchell S.V. Elkind, MD, Neurological Institute, 710 W 168th St, New York, NY 10032. E-mail mse13{at}columbia.edu
Background and Purpose—Serological evidence of infection with Chlamydia pneumoniae has been associated with cardiovascular disease in multiple epidemiological studies. The data on its association with ischemic stroke are limited. We sought to determine whether chronic C pneumoniae infection is associated with ischemic stroke in a multi-ethnic population.
Methods—The Northern Manhattan Stroke Study contains a
population-based, case-control study component. Cases had first
ischemic stroke and matched control subjects were derived
through random digit dialing. Titers of IgG, IgA, and IgM antibodies
specific for C pneumoniae were measured with the use of
microimmunofluorescence, and titers 
1:16 were
considered positive. Conditional logistic regression was used to
calculate odds ratios (ORs) and 95% confidence intervals (95% CIs)
after adjustment for medical, behavioral, and socioeconomic
factors.
Results—Eighty-nine cases and 89 control subjects were selected. Mean age among cases was 68.5±12.8 years; 53% were women and 15% of the subjects were white, 28% were black, and 54% were Hispanic. Elevated C pneumoniae IgA titers were significantly associated with risk of ischemic stroke after adjusting for other stroke risk factors (adjusted OR 4.51, 95% CI 1.44 to 14.06). IgG titers were less strongly associated with stroke risk (adjusted OR 2.59, 95% CI 0.87 to 7.75). The association of IgA with stroke risk was detected in both younger and older groups, in men and women, and in whites, blacks, and Hispanics. There was also a significant continuous increase in risk associated with the log-transformation of the titer for IgA (adjusted OR 1.32, 95% CI 1.05 to 1.66) but not IgG.
Conclusions—Serological evidence of chronic infection with C pneumoniae is associated with risk of ischemic stroke in an urban, multi-ethnic population. IgA titers may be a better marker of this risk than are IgG titers. This association is independent of other vascular disease risk factors. Further prospective epidemiological studies of the effect of this infection on stroke risk are warranted.
Key Words: atherosclerosis • cerebrovascular disorders • epidemiology • infection • risk factors
This article has been cited by other articles:
 |
|
 |
|
  J. Parratt, R. Tavendale, J. O'Riordan, D. Parratt, and R. Swingler Chlamydia pneumoniae-specific serum immune complexes in patients with multiple sclerosis Multiple Sclerosis, April 1, 2008; 14(3): 292 - 299. [Abstract] [PDF]
|
|
|
|
 |
|
 S Alamowitch, J Labreuche, P-J Touboul, F Eb, P Amarenco, and for the GENIC Investigators Chlamydia pneumoniae seropositivity in aetiological subtypes of brain infarction and carotid atherosclerosis: a case control study J. Neurol. Neurosurg. Psychiatry, February 1, 2008; 79(2): 147 - 151. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Circulation, June 20, 2006; 113(24): e873 - e923. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Stroke, June 1, 2006; 37(6): 1583 - 1633. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S.V. Elkind, M. L. C. Tondella, D. R. Feikin, B. S. Fields, S. Homma, and M. R. Di Tullio Seropositivity to Chlamydia pneumoniae Is Associated With Risk of First Ischemic Stroke Stroke, March 1, 2006; 37(3): 790 - 795. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Njamnshi, K. N. Blackett, J. N. Mbuagbaw, F. Gumedze, S. Gupta, and C. S. Wiysonge Chronic Chlamydia pneumoniae Infection and Stroke in Cameroon: A Case-Control Study Stroke, March 1, 2006; 37(3): 796 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Oliveira-Filho, L. C. Viana, R. M. Vieira-de-Melo, F. Faical, J. A. Torreao, F. A.G.A. Villar, and F. J.F.B. Reis Chagas Disease Is an Independent Risk Factor for Stroke: Baseline Characteristics of a Chagas Disease Cohort Stroke, September 1, 2005; 36(9): 2015 - 2017. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J G Ray, M M Mamdani, and W H Geerts Giant cell arteritis and cardiovascular disease in older adults Heart, March 1, 2005; 91(3): 324 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Lindsberg and A. J. Grau Inflammation and Infections as Risk Factors for Ischemic Stroke Stroke, October 1, 2003; 34(10): 2518 - 2532. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. G. Butchart, A. Ionescu, N. Payne, J. Giddings, G. L. Grunkemeier, and A. G. Fraser A New Scoring System to Determine Thromboembolic Risk After Heart Valve Replacement Circulation, September 9, 2003; 108(90101): II-68 - 74. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Lalla, I. B. Lamster, M. A. Hofmann, L. Bucciarelli, A. P. Jerud, S. Tucker, Y. Lu, P. N. Papapanou, and A. M. Schmidt Oral Infection With a Periodontal Pathogen Accelerates Early Atherosclerosis in Apolipoprotein E-Null Mice Arterioscler. Thromb. Vasc. Biol., August 1, 2003; 23(8): 1405 - 1411. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Agmon, B. K. Khandheria, I. Meissner, T. M. Petterson, W. M. O'Fallon, T. J. H. Christianson, D. O. Wiebers, T. F. Smith, J. M. Steckelberg, and A. J. Tajik Lack of association between Chlamydia pneumoniae seropositivity and aortic atherosclerotic plaques: A Population-Based transesophageal echocardiographic study J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1482 - 1487. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Slepenkin, V. Motin, L. M. de la Maza, and E. M. Peterson Temporal Expression of Type III Secretion Genes of Chlamydia pneumoniae Infect. Immun., May 1, 2003; 71(5): 2555 - 2562. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. D. Read, G. S. A. Myers, R. C. Brunham, W. C. Nelson, I. T. Paulsen, J. Heidelberg, E. Holtzapple, H. Khouri, N. B. Federova, H. A. Carty, et al. Genome sequence of Chlamydophila caviae (Chlamydia psittaci GPIC): examining the role of niche-specific genes in the evolution of the Chlamydiaceae Nucleic Acids Res., April 15, 2003; 31(8): 2134 - 2147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Falck, J. Gnarpe, L.-O. Hansson, K. Svardsudd, and H. Gnarpe Comparison of Individuals With and Without Specific IgA Antibodies to Chlamydia pneumoniae: Respiratory Morbidity and the Metabolic Syndrome Chest, November 1, 2002; 122(5): 1587 - 1593. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S.V. Elkind, R. Sciacca, B. Boden-Albala, S. Homma, and M. R. Di Tullio Leukocyte Count Is Associated With Aortic Arch Plaque Thickness Stroke, November 1, 2002; 33(11): 2587 - 2592. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.A. Erkens, O.H. Klungel, R.M.C. Herings, R.P. Stolk, J.A. Spoelstra, D.E. Grobbee, and H.G.M. Leufkens Use of fluorquinolones is associated with a reduced risk of coronary heart disease in diabetes mellitus type 2 patients Eur. Heart J., October 2, 2002; 23(20): 1575 - 1579. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Wizel, B. C. Starcher, B. Samten, Z. Chroneos, P. F. Barnes, J. Dzuris, Y. Higashimoto, E. Appella, and A. Sette Multiple Chlamydiapneumoniae Antigens Prime CD8+ Tc1 Responses That Inhibit Intracellular Growth of This Vacuolar Pathogen J. Immunol., September 1, 2002; 169(5): 2524 - 2535. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kohara, Y. Tabara, Y. Yamamoto, M. Igase, and T. Miki Chlamydia pneumoniae Seropositivity Is Associated With Increased Plasma Levels of Soluble Cellular Adhesion Molecules in Community-Dwelling Subjects: The Shimanami Health Promoting Program (J-SHIPP) Study Stroke, June 1, 2002; 33(6): 1474 - 1479. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Stollberger and J. Finsterer Role of Infectious and Immune Factors in Coronary and Cerebrovascular Arteriosclerosis Clin. Vaccine Immunol., March 1, 2002; 9(2): 207 - 215. [Full Text] [PDF]
|
|
|
|
|
|
J. Danesh, P. Whincup, S. Lewington, M. Walker, L. Lennon, A. Thomson, Y.-K. Wong, X. Zhou, and M. Ward Chlamydia pneumoniae IgA titres and coronary heart disease. Prospective study and meta-analysis Eur. Heart J., March 1, 2002; 23(5): 371 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Gorelick Stroke Prevention Therapy Beyond Antithrombotics: Unifying Mechanisms in Ischemic Stroke Pathogenesis and Implications for Therapy: An Invited Review Stroke, March 1, 2002; 33(3): 862 - 875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Elkind, J. Cheng, B. Boden-Albala, T. Rundek, J. Thomas, H. Chen, L. E. Rabbani, R. L. Sacco, and A. G. Thrift Tumor Necrosis Factor Receptor Levels Are Associated With Carotid Atherosclerosis * Editorial Comment Stroke, January 1, 2002; 33(1): 31 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. U. Heuschmann, D. Neureiter, M. Gesslein, B. Craiovan, M. Maass, G. Faller, G. Beck, B. Neundoerfer, and P. L. Kolominsky-Rabas Association Between Infection With Helicobacter pylori and Chlamydia pneumoniae and Risk of Ischemic Stroke Subtypes: Results From a Population-Based Case-Control Study Stroke, October 1, 2001; 32(10): 2253 - 2258. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Virok, Z. Kis, L. Karai, L. Intzedy, K. Burian, A. Szabo, B. Ivanyi, E. Gonczol, and M. S. Elkind Chlamydia pneumoniae in Atherosclerotic Middle Cerebral Artery Editorial Comment Stroke, September 1, 2001; 32(9): 1973 - 1976. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Sacco Newer risk factors for stroke Neurology, September 1, 2001; 57(90002): S31 - 34. [Abstract] [Full Text]
|
|
|
|
|
|
M. S. Elkind, J. Cheng, B. Boden-Albala, M. C. Paik, and R. L. Sacco Elevated White Blood Cell Count and Carotid Plaque Thickness : The Northern Manhattan Stroke Study Stroke, April 1, 2001; 32(4): 842 - 849. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. LaBiche, D. Koziol, T. C. Quinn, C. Gaydos, S. Azhar, G. Ketron, S. Sood, and T. J. DeGraba Presence of Chlamydia pneumoniae in Human Symptomatic and Asymptomatic Carotid Atherosclerotic Plaque Stroke, April 1, 2001; 32(4): 855 - 860. [Abstract] [Full Text] [PDF]
|
|