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Chlamydia pneumoniae and Atherosclerosis following Carotid Endarterectomy

Published online by Cambridge University Press:  02 December 2014

Babak S. Jahromi ,
Michael D. Hill ,
Kate Holmes ,
Stuart Hutchison ,
William S. Tucker  and
Brian Chiu
Babak S. Jahromi
Affiliation:
Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON Section of Neurosurgery, University of Chicago, Chicago IL USA
Michael D. Hill
Affiliation:
Pathology, St. Michael's Hospital, University of Toronto, Toronto, ON Department of Clinical Neurosciences, University of Calgary, Calgary, AB
Kate Holmes
Affiliation:
Department of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, ON
Stuart Hutchison
Affiliation:
Department of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, ON
William S. Tucker
Affiliation:
Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON
Brian Chiu
Affiliation:
Pathology, St. Michael's Hospital, University of Toronto, Toronto, ON Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
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Abstract

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Background:

Seroepidemiological studies have shown an association between raised antibody titres against Chlamydia pneumoniae, and carotid atherosclerosis or stroke. However, direct evidence for a causal link between arterial infection with C. pneumoniae and carotid disease remains weak. We hypothesized that long-term follow-up of patients with pathologically-proven arterial C. pneumoniae infection might provide further insight into the role of C. pneumoniae in carotid atherosclerosis.

Methods:

We followed a cohort of 70 carotid endarterectomy patients for ipsilateral restenosis, contralateral progression, and all-cause mortality (four year median follow-up period). All patients had presence or absence of C. pneumoniae in their carotid plaques documented by immunohistochemistry after endarterectomy. A survival function was generated and the log-rank test was used to assess the difference in survival between subjects with and without documented chlamydial infection in their plaque.

Results:

Baseline demographic and cardiovascular risk factors were similar between the two groups, and survival analysis demonstrated no difference (p>0.05) in all-cause mortality, or all-cause mortality combined with restenosis and progression.

Conclusion:

Our data finds no causal role for C. pneumoniae in restenosis or progression of carotid disease or mortality in this patient population with advanced carotid atherosclerosis.

Résumé:

RÉSUMÉ:Introduction:

Des études séroépidémiologiques ont montré une association entre un taux élevé d'anticorps contre C. pneumoniae et l'athérosclérose carotidienne ou l'accident vasculaire cérébral. Cependant, les preuves directes qu'il existe un lien causal entre l'infection artérielle à C. pneumoniae et la maladie carotidienne demeurent faibles. Nous avons émis l'hypothèse que le suivi à long terme de patients porteurs d'une infection artérielle à C. pneumoniae prouvée en anatomopathologie pourrait fournir d'autres indices sur le rôle de C. pneumoniae dans l'athérosclérose carotidienne.

Méthodes:

Nous avons suivi une cohorte de 70 patients ayant subi une endartérectomie carotidienne, pour resténose ipsilatérale, progression contralatérale et mortalité toute cause (suivi médian de quatre ans). Chez tous les patients, la présence ou l'absence de C. pneumoniae dans les plaques carotidiennes a été documenté par immunohistochimie après l'endartérectomie. La différence dans la survie entre les sujets avec et sans infection à C. pneumoniae dans leurs plaques a été évaluée en générant une fonction de survie et en utilisant le test du log-rank.

Résultats:

Les données démographiques et les facteurs de risque étaient similaires entre les deux groupes et l'analyse de survie n'a pas montré de différence (p > 0,05) dans la mortalité toute cause ou la mortalité toute cause combinée à la resténose et à la progression.

Conclusions:

Nos données ne sont pas en faveur d'un rôle causal de C. pneumoniae dans la resténose ou la progression de la maladie carotidienne ou dans la mortalité dans cette population de patients porteurs d'athérosclérose carotidienne sévère.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 4 , November 2003 , pp. 333 - 339
Copyright
Copyright © The Canadian Journal of Neurological 2003

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