A large epidemiological study on the interaction between inflammation, infection and antioxidants in the development of atherosclerosis

为了获得预防心血管疾病的流行病学证据，我们调查了炎症、感染和抗氧化剂在动脉粥样硬化、冠心病和中风发生中的作用及其相互作用。受试者约有10万名年龄在40-79岁的日本男性和女性。为研究C反应蛋白、肺炎衣原体和幽门螺杆菌抗体效价、抗氧化剂消耗、标志物以及传统危险因素与冠心病和中风风险的关系，进行了一项前瞻性嵌套式病例对照研究。在日本，食用鱼类可预防冠心病的发生(循环2006)。食用水果和蔬菜也与中风的发病率和死亡率以及冠心病的死亡率成反比。膳食中叶酸、维生素B6和B12的摄入量与冠心病的发病率呈负相关。此外，体力活动、钙、维生素C和E的摄入量，以及血清α-生育酚和阿魏酸等抗氧化标记物都是心血管疾病的保护因素。在日本，我们首次发现肺炎衣原体高敏C反应蛋白和IgA滴度是冠心病的危险因素。血清α-生育酚浓度与总心血管疾病死亡率呈负相关，这种关联在高敏C反应蛋白或肺炎衣原体IgA滴度较高的人中更为明显。这些相互作用表明，对于患有慢性炎症或持续感染肺炎衣原体的高危人群来说，足够的抗氧化剂摄入量是重要的。

To obtain epidemiological evidence for prevention of cardiovascular disease, we investigated the contribution of inflammation, infection and antioxidants and their interaction in the development of atherosclerosis, coronary heart disease and stroke. The subjects were approximately 100,000 Japanese men and women aged 40-79. A prospective nested case-control study was conducted to examine the associations of C-reactive protein, antibody titers of Chlamydia pneumoniae and Helicobacter pylori and antioxidant consumption and markers as well as conventional risk factors with the risk of coronary heart disease and stroke.Consumption of fish was protective against the development of coronary heart disease among Japanese (Circulation 2006). Consumption of fruits and vegetables was also inversely associated with the incidence of and mortality from stroke and mortality from coronary heart disease. Dietary intake of folate, vitamins B6 and B12 was inversely associated with the incidence of coronary heart disease. Furthermore, physical activity, consumption of calcium, vitamins C and E, and antioxidant markers such as serum alpha-tocopherol and ferulic acid were protective factors for cardiovascular disease. We found high-sensitive C reactive protein and IgA titer of Chlamydia pneumoniae was risk factor for coronary heart disease in Japanese for the first time.There was an inverse association between serum alpha-tocopherol concentrations and mortality from total cardiovascular disease, and this association was more evident among persons with higher concentrations of high-sensitive C reactive protein or Chlamydia pneumoniae IgA titer. These interactions suggest the importance of sufficient antioxidant consumption for high risk populations with chronic inflammation or continuous infection of Chlamydia pneumoniae.