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David H. Thom, MD, PhD; J. Thomas Grayston, MD; David S. Siscovick, MD, MPH; San-Pin Wang, MD; Noel S. Weiss, MD, DrPH; Janet R. Daling, PhD

JAMA. 1992;268(1):68-72.

Abstract
Objective.
—To evaluate the association between prior infection with Chlamydia pneumoniae, as measured by IgG antibody, and coronary artery disease.

Design.
—A population-based, case-control study.

Setting.
—Group Health Cooperative of Puget Sound, a Seattle-based health maintenance organization.

Participants.
—Men 55 years of age and younger and women 65 years of age and younger. Cases (n=171) were members of Group Health Cooperative undergoing diagnostic coronary angiography who had at least one coronary artery lesion occupying 50% or more of the luminal diameter. The population controls (n=120) were Group Health Cooperative members without known coronary heart disease.

Main Outcome Measure.
—The adjusted odds ratio (OR) for coronary artery disease associated with prior Cpneumoniae infection as measured by the presence of IgG antibody.

Results.
—After adjusting for age, gender, and calendar quarter of blood drawing, the OR for coronary artery disease associated with the presence of antibody was 2.6 (95% confidence interval, 1.4 to 4.8). The association was limited to cigarette smokers, in whom the OR was 3.5 (95% confidence interval, 1.7 to 7.0). Among never-smokers, the OR was 0.8 (95% confidence interval, 0.3 to 1.9). When cases and controls were restricted to those assayed concurrently, the adjusted OR (smokers and nonsmokers combined) was 4.2 (95% confidence interval, 1.8 to 10.0). Adjustment for serum cholesterol, hypertension, alcohol use, diabetes, and socioeconomic status did not change these results. Only a weak association was found when cases were compared with 63 subjects whose angiographic results were normal (OR, 1.2; 95% confidence interval, 0.6 to 2.2).

Conclusions.
—These results generally support the previously reported association between Cpneumoniae infection and coronary heart disease. However, caution should be used in interpreting the basis for this association.

(JAMA. 1992;268:68-72)

Author Affiliations
From the Division of Family and Community Medicine, Stanford University School of Medicine, Palo Alto, Calif (Dr Thom), and the Departments of Epidemiology (Drs Grayston, Siscovick, Weiss, and Daling), Pathobiology (Drs Grayston and Wang); and Medicine (Dr Siscovick), University of Washington, Seattle.

Footnotes
Reprint requests to Division of Family and Community Medicine, Stanford University School of Medicine, 703 Welch Rd, Suite G-1, Palo Alto, CA 94304-1760 (Dr Thom).

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