(Circulation. 1995;91:23-27.)
© 1995 American Heart Association, Inc.
Articles |
Anti-Cardiolipin Antibodies and Risk of Myocardial Infarction in a Prospective Cohort of Middle-Aged Men
From the National Public Health Institute (O.V., M.P., K.A., T.P.); and the First Department of Medicine (M.M., V.M., L.T.), University of Helsinki, Finland.
Correspondence to Outi Vaarala, MD, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland.
Background Data concerning the relation between anti-phospholipid (aPL) antibodies and myocardial infarction in subjects without evidence of overt autoimmune disease are conflicting. All published studies have been performed on survivors of myocardial infarction or in patients with established coronary heart disease. The purpose of the present study was to determine whether the presence of aPL antibodies, namely, anti-cardiolipin (aCL) antibodies, carries a risk for myocardial infarction in a prospective cohort.
Methods and Results The sera to be studied were drawn at
entry from middle-aged dyslipidemic men (non–high-density lipoprotein
cholesterol, 
5.2 mmol/L) participating in the Helsinki Heart Study, a
5-year coronary primary prevention trial with gemfibrozil. Samples were
tested for IgG-class antibodies to cardiolipin by an ELISA. The risk
was estimated with logistic regression analysis using a nested
case-control design with 133 patients (myocardial infarction or cardiac
death) and 133 control subjects, matched for treatment
(gemfibrozil/placebo) and geographical area. The aCL antibody level, as
expressed in optical density units, was significantly higher in
patients than in control subjects (0.417 versus 0.361;
P<.005). Subjects with the antibody level in the highest
quartile of distribution had a relative risk for myocardial infarction
of 2.0 (95% confidence interval, 1.1 to 3.5) compared with the
remainder of the population. This risk was independent of confounding
factors, such as age, smoking, systolic blood pressure, low-density
lipoprotein (LDL), and high-density lipoprotein. There was a
correlation between the levels of aCL antibodies and antibodies to
oxidized LDL (r=.40, P<.001), and their joint
effect was additive for the risk.
Conclusions In a prospective cohort of healthy middle-aged men, the presence of a high aCL antibody level is an independent risk factor for myocardial infarction or cardiac death. Antibodies to cardiolipin and oxidized LDL may, at least in part, represent cross-reactive antibody populations.
Key Words: lipoproteins • antibodies • thrombosis • infarction
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