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Association between infectious burden, socioeconomic status, and ischemic stroke.

Authors
  • Palm, Frederick1
  • Pussinen, Pirkko J2
  • Aigner, Annette3
  • Becher, Heiko4
  • Buggle, Florian5
  • Bauer, Matthias F6
  • Grond-Ginsbach, Caspar7
  • Safer, Anton8
  • Urbanek, Christian5
  • Grau, Armin J5
  • 1 Department of Neurology, Klinikum Ludwigshafen, Germany. Electronic address: [email protected] , (Germany)
  • 2 Oral and Maxillofacial Diseases, University of Helsinki, Finland. , (Finland)
  • 3 Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany. , (Germany)
  • 4 Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany; Institute of Public Health, University of Heidelberg, Germany. , (Germany)
  • 5 Department of Neurology, Klinikum Ludwigshafen, Germany. , (Germany)
  • 6 Clinical Chemistry, Klinikum Ludwigshafen, Germany. , (Germany)
  • 7 Department of Neurology, University of Heidelberg, Germany. , (Germany)
  • 8 Institute of Public Health, University of Heidelberg, Germany. , (Germany)
Type
Published Article
Journal
Atherosclerosis
Publication Date
Nov 01, 2016
Volume
254
Pages
117–123
Identifiers
DOI: 10.1016/j.atherosclerosis.2016.10.008
PMID: 27728851
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Infectious diseases contribute to stroke risk, and are associated with socioeconomic status (SES). We tested the hypotheses that the aggregate burden of infections increases the risk of ischemic stroke (IS) and partly explains the association between low SES and ischemic stroke. In a case-control study with 470 ischemic stroke patients and 809 age- and sex-matched controls, randomly selected from the population, antibodies against the periodontal microbial agents Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, against Chlamydia pneumonia, Mycoplasma pneumoniae (IgA and IgG), and CagA-positive Helicobacter pylori (IgG) were assessed. IgA seropositivity to two microbial agents was significantly associated with IS after adjustment for SES (OR 1.45 95% CI 1.01-2.08), but not in the fully adjusted model (OR 1.32 95% CI 0.86-2.02). By trend, cumulative IgA seropositivity was associated with stroke due to large vessel disease (LVD) after full adjustment (OR 1.88, 95% CI 0.96-3.69). Disadvantageous childhood SES was associated with higher cumulative seropositivity in univariable analyses, however, its strong impact on stroke risk was not influenced by seroepidemiological data in the multivariable model. The strong association between adulthood SES and stroke was rendered nonsignificant when factors of dental care were adjusted for. Infectious burden assessed with five microbial agents did not independently contribute to ischemic stroke consistently, but may contribute to stroke due to LVD. High infectious burden may not explain the association between childhood SES and stroke risk. Lifestyle factors that include dental negligence may contribute to the association between disadvantageous adulthood SES and stroke. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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