Human Papillomavirus and Cardiovascular Disease Among U.S. Women in the National Health and Nutrition Examination Survey, 2003 to 2006
Is human papillomavirus (HPV) associated with occurrence of cardiovascular disease (CVD) among women?
A total of 3,467 females (ages 20-59 years) were interviewed for the 2003 to 2006 National Health and Nutrition Examination Survey, of which 3,330 underwent an examination. From the examinees, after excluding women with incomplete vaginal swab specimens, no vaginal swab specimens, or missing data on other covariates, 2,450 women were included in the present study. Self-collected vaginal swab specimens were sent for HPV DNA analysis by L1 consensus polymerase chain reaction followed by type-specific hybridization. CVD was ascertained by self-reported diagnosis of myocardial infarction or stroke. Those excluded were significantly more likely to be of all other races (race/ethnicity other than Hispanic, black, or white) (8.8% vs. 4.4%, p < 0.001), and to be younger (age 34.0 years vs. 37.7 years, p < 0.001).
Among study participants (n = 2,450, mean age 37.9 years), 1,141 women (46.6%) were positive for HPV DNA. Five hundred seventy-three women (23.2% of study population) had cancer-associated HPV types. Women without HPV infection tended to be nonsmokers and to drink less, whereas women with cancer-associated HPV types were more likely to be younger. There was no difference in prevalence of diabetes mellitus, lung disease, liver disease, thyroid disease, and cancer between groups. A total of 60 women (2.5%) reported having either myocardial infarction or stroke, of which 39 women were HPV DNA positive, and 21 were negative. Odds ratio of CVD comparing women with presence of vaginal HPV DNA to those without was 2.30 (95% confidence interval [CI], 1.27-4.16) after controlling for demographics, health/sex behaviors, medical comorbidities, CV risk factors, and management. After controlling for the same factors, among women with cancer-associated HPV types, the odds of CVD were 2.86 (95% CI, 1.43-5.70) as compared to women who were negative for HPV. No association between HPV and metabolic risk factors was observed.
The authors concluded that HPV infection, in particular cancer-associated oncogenic types, is associated with CVD among women.
This study provides an interesting hypothesis in that there may be an association between HPV infection and CVD. As the authors point out, oncogenic proteins induce degradation of tumor suppressor protein p53, and inactivation of this protein has been associated with the atherosclerosis process. Whether prevention of HPV infection results in lowering CVD events remains the significant unanswered question upon which the clinical significance of these findings rests.
Keywords: Papillomavirus Infections, Myocardial Infarction, Stroke, Tumor Suppressor Protein p53, Thyroid Diseases, Cardiovascular Diseases, Risk Factors, Diabetes Mellitus, Consensus, Polymerase Chain Reaction
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