{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:12:25Z","timestamp":1790172745752,"version":"4.1.0"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2000,1,25]]},"abstract":"<jats:p>\n            <jats:italic>Background<\/jats:italic>\n            \u2014The role of infections and inflammation in the pathophysiology of coronary heart disease is emerging. We studied the independent and joint effects of these 2 components on coronary risk.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods and Results<\/jats:italic>\n            \u2014We measured baseline levels of C-reactive protein (CRP) and antibodies to adenovirus, enterovirus, cytomegalovirus, and herpes simplex virus as well as to\n            <jats:italic>Chlamydia pneumoniae<\/jats:italic>\n            (\n            <jats:italic>Cpn<\/jats:italic>\n            ) and\n            <jats:italic>Helicobacter pylori<\/jats:italic>\n            in 241 subjects who suffered either myocardial infarction or coronary death during the 8.5-year trial in the Helsinki Heart Study, a coronary primary prevention trial. The 241 controls in this nested case-control study were subjects who completed the study without coronary events. Antibody levels to herpes simplex type I (HSV-1) and to\n            <jats:italic>Cpn<\/jats:italic>\n            were higher in cases than in controls, whereas the distributions of antibodies to other infectious agents were similar. Mean CRP was higher in cases (4.4 versus 2.0 mg\/L;\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001), and high CRP increased the risks associated with smoking and with high antimicrobial antibody levels. The odds ratios in subjects with high antibody and high CRP levels were 25.4 (95% CI 2.9\u2013220.3) for HSV-1 and 5.4 (95% CI 2.4\u201312.4) for\n            <jats:italic>Cpn<\/jats:italic>\n            compared with subjects with low antibody levels and low CRP. High antibody levels to either HSV-1 or to\n            <jats:italic>Cpn<\/jats:italic>\n            increased the risk independently of the other, and their joint effect was close to additive.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014Two chronic infections, HSV-1 and\n            <jats:italic>Cpn<\/jats:italic>\n            , increase the risk of coronary heart disease. The effect is emphasized in subjects with ongoing inflammation, denoted by increased CRP levels.\n          <\/jats:p>","DOI":"10.1161\/01.cir.101.3.252","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:42:29Z","timestamp":1339461749000},"page":"252-257","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":224,"title":["Infections, Inflammation, and the Risk of Coronary Heart Disease"],"prefix":"10.1161","volume":"101","author":[{"given":"Merja","family":"Roivainen","sequence":"first","affiliation":[{"name":"From the Enterovirus Laboratory (M.R., M.V.-K., T.H.) and the Laboratory of Immunobiology (T.P.), National Public Health Institute, and the Wihuri Research Institute (P.T.), Helsinki; the Department in Oulu, National Public Health Institute, Oulu (M.L., P.S.); and the Department of Medicine, Helsinki University Central Hospital, Helsinki (L.T., V.M., M.M.), Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarit","family":"Viik-Kajander","sequence":"additional","affiliation":[{"name":"From the Enterovirus Laboratory (M.R., M.V.-K., T.H.) and the Laboratory of Immunobiology (T.P.), National Public Health Institute, and the Wihuri Research Institute (P.T.), Helsinki; the Department in Oulu, National Public Health Institute, Oulu (M.L., P.S.); and the Department of Medicine, Helsinki University Central Hospital, Helsinki (L.T., V.M., M.M.), Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Palosuo","sequence":"additional","affiliation":[{"name":"From the Enterovirus Laboratory (M.R., M.V.-K., T.H.) and the Laboratory of Immunobiology (T.P.), National Public Health Institute, and the Wihuri Research Institute (P.T.), Helsinki; the Department in Oulu, National Public Health Institute, Oulu (M.L., P.S.); and the Department of Medicine, Helsinki University Central Hospital, Helsinki (L.T., V.M., M.M.), Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petri","family":"Toivanen","sequence":"additional","affiliation":[{"name":"From the Enterovirus Laboratory (M.R., M.V.-K., T.H.) and the Laboratory of Immunobiology (T.P.), National Public Health Institute, and the Wihuri Research Institute (P.T.), Helsinki; the Department in Oulu, National Public Health Institute, Oulu (M.L., P.S.); and the Department of Medicine, Helsinki University Central Hospital, Helsinki (L.T., V.M., M.M.), Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maija","family":"Leinonen","sequence":"additional","affiliation":[{"name":"From the Enterovirus Laboratory (M.R., M.V.-K., T.H.) and the Laboratory of Immunobiology (T.P.), National Public Health Institute, and the Wihuri Research Institute (P.T.), Helsinki; the Department in Oulu, National Public Health Institute, Oulu (M.L., P.S.); and the Department of Medicine, Helsinki University Central Hospital, Helsinki (L.T., V.M., M.M.), Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pekka","family":"Saikku","sequence":"additional","affiliation":[{"name":"From the Enterovirus Laboratory (M.R., M.V.-K., T.H.) and the Laboratory of Immunobiology (T.P.), National Public Health Institute, and the Wihuri Research Institute (P.T.), Helsinki; the Department in Oulu, National Public Health Institute, Oulu (M.L., P.S.); and the Department of Medicine, Helsinki University Central Hospital, Helsinki (L.T., V.M., M.M.), Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena","family":"Tenkanen","sequence":"additional","affiliation":[{"name":"From the Enterovirus Laboratory (M.R., M.V.-K., T.H.) and the Laboratory of Immunobiology (T.P.), National Public Health Institute, and the Wihuri Research Institute (P.T.), Helsinki; the Department in Oulu, National Public Health Institute, Oulu (M.L., P.S.); and the Department of Medicine, Helsinki University Central Hospital, Helsinki (L.T., V.M., M.M.), Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesa","family":"Manninen","sequence":"additional","affiliation":[{"name":"From the Enterovirus Laboratory (M.R., M.V.-K., T.H.) and the Laboratory of Immunobiology (T.P.), National Public Health Institute, and the Wihuri Research Institute (P.T.), Helsinki; the Department in Oulu, National Public Health Institute, Oulu (M.L., P.S.); and the Department of Medicine, Helsinki University Central Hospital, Helsinki (L.T., V.M., M.M.), Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tapani","family":"Hovi","sequence":"additional","affiliation":[{"name":"From the Enterovirus Laboratory (M.R., M.V.-K., T.H.) and the Laboratory of Immunobiology (T.P.), National Public Health Institute, and the Wihuri Research Institute (P.T.), Helsinki; the Department in Oulu, National Public Health Institute, Oulu (M.L., P.S.); and the Department of Medicine, Helsinki University Central Hospital, Helsinki (L.T., V.M., M.M.), Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Ma\u0308ntta\u0308ri","sequence":"additional","affiliation":[{"name":"From the Enterovirus Laboratory (M.R., M.V.-K., T.H.) and the Laboratory of Immunobiology (T.P.), National Public Health Institute, and the Wihuri Research Institute (P.T.), Helsinki; 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