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Hepatitis A virus seropositivity and coronary artery disease.

To the Editor:

We read with great interest the paper by Marek Smieja and colleagues1 showing that exposure to hepatitis A virus (HAV) was not associated with an excess risk of subsequent myocardial infarction, stroke, or cardiovascular death in Heart Outcomes Prevention Evaluation (HOPE) study patients. Total pathogen score based on seropositivity of 4 pathogens ( Chlamydia pneumoniae , Helicobacter pylori , HAV, and cytomegalovirus) predicted a small increased hazard of cardiovascular events.

Many intracellular pathogens that induce a long-lasting antibody could contribute to atherogenesis. It is not known if persistent infection is actually required or if effects …