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Review
. 2017 Jul 6;6(7):e005025.
doi: 10.1161/JAHA.116.005025.

Cytomegalovirus Infection and Relative Risk of Cardiovascular Disease (Ischemic Heart Disease, Stroke, and Cardiovascular Death): A Meta-Analysis of Prospective Studies Up to 2016

Haoran Wang  1 , Geng Peng  2 , Jing Bai  3 , Bing He  4 , Kecheng Huang  5 , Xinrong Hu  2 , Dongliang Liu  1
Affiliations
Review

Cytomegalovirus Infection and Relative Risk of Cardiovascular Disease (Ischemic Heart Disease, Stroke, and Cardiovascular Death): A Meta-Analysis of Prospective Studies Up to 2016

Haoran Wang et al. J Am Heart Assoc. .

Abstract

Background: Several studies have suggested that cytomegalovirus infection is likely associated with an increased relative risk of cardiovascular disease (CVD); however, the results are inconsistent. We aimed to provide a systematic review and meta-analysis of community-based prospective studies assessing the association between cytomegalovirus infection and relative risk of CVD.

Methods and results: We searched Medline and EMBASE to retrieve prospective studies that reported risk estimates of the association between cytomegalovirus infection and relative risk of CVD. The search yielded 10 articles including a total of 34 564 participants and 4789 CVD patients. Overall, exposure to cytomegalovirus infection was associated with a 22% (relative risk: 1.22, 95% CI: 1.07-1.38, P=0.002) increased relative risk of future CVD. We estimated that 13.4% of CVD incidence could be attributable to cytomegalovirus infection.

Conclusions: In conclusion, cytomegalovirus infection is associated with a significantly increased relative risk of CVD.

Keywords: cardiovascular disease risk factors; cytomegalovirus; infectious disease; meta‐analysis; prospective cohort study; virus.

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Figures

Figure 1
Figure 1
Flowchart on the selection of eligible studies. CMV indicates cytomegalovirus; CVD, cardiovascular disease.
Figure 2
Figure 2
Association between CMV infection and risk of CVDs. Relative risks (RRs) in the individual studies are indicated by the data markers (shaded boxes around the data markers reflect the statistical weight of the study); 95% CIs are indicated by the error bars. The pooled‐effect estimate with its 95% CI is depicted as a diamond. CMV indicates cytomegalovirus; CVDs, cardiovascular diseases.
Figure 3
Figure 3
Funnel plots for bias assessment. Each point indicates an individual study. Funnel plots did not show obvious asymmetry. lnRR indicates natural logarithm of relative risk; se of lnRR, standard error of natural logarithm of relative risk.
Figure 4
Figure 4
Sensitivity analysis by omitting 1 study at a time. The figure indicates that none of the individual studies influenced the pooled RR qualitatively. RR indicates relative risk.
Figure 5
Figure 5
Associations between CMV infection and relative risk of IHD, stroke, and cardiovascular mortality. Relative risks (RRs) in the individual studies are indicated by the data markers. The size of the data markers indicates the weight of the study. The diamond data markers indicate the pooled RRs. CMV indicates cytomegalovirus; IHD, ischemic heart disease.
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