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(Circulation. 1999;100:e139.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Cytomegalovirus Infection and Coronary Heart Disease

F. Javier Nieto, MD, PhD; Moyses Szklo, MD, DrPH

Department of Epidemiology, Johns Hopkins University, Baltimore, Md

Paul D. Sorlie, PhD

National Heart, Lung, and Blood Institute Bethesda, Md

	Introduction

 
To the Editor:

We read with great interest the article by Ridker et al¹ reporting no positive association between baseline cytomegalovirus (CMV) and herpes simplex virus serum antibodies and incidence of myocardial infarction or stroke in the Physician’s Health Study. We agree with the authors that prospective epidemiological data are scarce, and this study fills an important gap. However, we must point out that their citation of our previous study² together with other "cross-sectional or retrospective studies" is misleading. Ridker et al state that in these previous studies, "evidence of exposure to these viruses was ascertained after rather than before the development of atherothrombosis."¹ In fact, in our study, antibodies were measured in serum that was collected 13 to 16 years before carotid atherosclerosis was measured, even though this was done "retrospectively." Thus, the temporal relation between exposure and outcome in our historical ("nonconcurrent") cohort study is similar to that in a "concurrent" prospective design.

We believe that our finding of a strong association between baseline CMV antibodies and subclinical carotid atherosclerosis (in individuals free of clinical disease) is consistent with the speculation by Ridker et al that "herpetic infection might lead to accelerated atherosclerosis progression without necessarily increasing rates of clinical thrombosis."¹

Negative seroepidemiological studies of infections and atherosclerosis may be the result of dilution bias due to nondifferential misclassification. CMV antibodies are poorly correlated with the presence of CMV DNA in atheroma specimens.³ Thus, even though Ridker et al report good repeatability of their antibody measurements, dilution bias . . . [Full Text of this Article]

Paul M. Ridker, MD; Charles H. Hennekens, MD; Meir J. Stampfer, MD; Fred Wang, MD

Brigham and Women’s Hospital, Boston, Mass