Systemic inflammation: subclinical UTI may trigger acute coronary syndrome, study suggests

OB/GYN News, May 15, 2004 by Bruce Jancin

NEW ORLEANS -- Subclinical urinary tract infection may be an important proximate cause of acute coronary syndromes. Dr. John B. Sims said at the annual meeting of the American College of Cardiology.

His single-center, case-control, retrospective study showed that 27% of 100 consecutive patients had a urinary tract infection (UTI) at the time they presented to the hospital with an acute coronary syndrome (ACS), compared with only 11% of 100 matched control subjects undergoing elective coronary artery bypass graft surgery.

After adjustment for between-group differences in hyperlipidemia, history of hypertension, and other cardiovascular risk factors, the odds of having a UTI were 2.99-fold greater in patients with ACS than in controls, according to Dr. Sims of the University of Texas, Dallas.

A causative relationship between subclinical UTI and ACS is rendered plausible by the central role inflammation has assumed in the atherosclerotic process in recent years. The proposed scenario involves the release of inflammatory mediators into the blood as the body tries to eradicate the urinary infection, with a resultant ratcheting upward of systemic inflammation to the point that coronary plaque destabilization occurs, he observed.

"The take-home lesson of this study is, it's important to realize that infection is definitely playing a role in patients who present with heart attack. Perhaps we need to be more vigorous, especially in outpatient settings, in screening our patients for UTI and other ongoing subclinical infections," Dr. Sims told cardiologists. "Find your patients who have UTIs and treat them early, because this study suggests if we don't and they have underlying heart disease, they may eventually come into the hospital with a heart attack triggered by that infection."

BY BRUCE JANCIN

Denver Bureau