Higher Immunoglobulin G Antibody Levels Against Cytomegalovirus Are Associated With Incident Ischemic Heart Disease in the Population-Based EPIC-Norfolk Cohort

Background. Cytomegalovirus (CMV) is associated with ischemic heart disease (IHD) among organ transplant recipients. The relationship between the levels of antibody for CMV with IHD in immunocompetent individuals is uncertain. Methods. We measured baseline CMV immunoglobulin G (IgG) levels in 12 574 participants without IHD from the population-based EPIC-Norfolk cohort, aged 40-70 years old at recruitment in 1993-1997. Underlying causes of death or hospitalization until 31 March 2008 were abstracted from death certificates and a database of hospital admissions, respectively. Results. Of the participants, 58% were seropositive for CMV. After a mean follow-up of 12 years (standard deviation, 2.2 years), 1356 first-time IHD events occurred. After adjustment for classic IHD risk factors, belonging to the highest antibody group was associated with an increased risk of incident IHD, compared with seronegativity (hazard ratio, 1.22; 95% confidence interval, 1.05-1.42). After additional adjustment for measures of social class, inflammation, and possible confounders, this association was unchanged (hazard ratio, 1.21; 95% confidence interval, 1.04-11.41). Conclusions. This is the first population study to show that CMV IgG antibody levels are related to incident IHD compared to seronegativity. Studies correlating CMV antibody levels with direct measurements of active infection will be necessary.