HPV infection linked to heart disease in women.

Research has shown that high blood pressure, cigarette smoking and diabetes are important contributors to the development of cardiovascular (heart) disease. About 1 in 5 individuals with heart disease do not have any of the conventional risk factors.1 Therefore; additional factors play a role in the process and human papillomavirus (HPV) is thought to be one of these non-traditional factors.

HPV has remained the most common sexually transmitted infection, affecting over 20 million people in the United States alone, with 6 million people, becoming newly infected each year.2 About half of all sexually active males and females will acquire this virus at some point in their lives.2 In a representative national survey, about 1 in 3 women aged 14-59 years are infected with this virus.3

Since most people who are infected with HPV have no symptoms, many of those who are infected are unaware that they carry the virus thereby causing an increased and sustained spread of this infection. Complications such as warts, and cancers of the throat, penis, anus and cervix might take a while to develop. With a slew of sexually transmitted diseases confronting young people today, HPV has become one of the most important causative agents responsible for a number of complications and cancers.

Even though HPV is sexually transmitted, its grave effects are not confined to the reproductive organs alone but are more extensive to include cancers and most recently, have been found to be associated with cardiovascular diseases, myocardial infarction and strokes in women.4

A recent study has shown a strong association between HPV and heart disease in women.
This study was an analysis from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2006.4 Findings from this study were recently published in the peer-reviewed Journal of American College of Cardiology.

The data was analyzed for 2,450 women aged 20 — 59 years. The average age of women participating in this study was 37.9 years. Of the 60 females who had coronary artery disease, 39 of these women were positive for HPV DNA at testing. The likelihood of having cardiovascular disease in the presence of a positive HPV DNA was twice that of HPV DNA negative women, even after controlling for other factors such as blood pressure, medical conditions, health/sex behaviors, cardiovascular risk burden and management.
In fact the likelihood of having a cardiovascular disease when positive for the cancer causing HPV types was close to three times that seen in HPV negative women.4

The researchers for this study suggest that the mechanism by which this association occurs is due to the ability of the HPV cancer-causing products to degrade two essential proteins known as the retinoblastoma and p53 tumor-suppressor proteins, which are necessary in regulating the process of hardening of blood vessels.5,6

Young men and women become infected with HPV everyday via oral, vaginal and anal sex. The attendant complications are now even further reaching than once thought. Although the role of HPV infection and heart disease is still unknown in men, the burden of this virus and its complications is disproportionately being borne by women. It is essential to appreciate this burden so that prevention efforts and interventions are targeted at the demographic that is worst hit by this menace.

This study is important because it highlights the importance of prevention of acquisition of HPV infection. Sexual risk avoidance is the most certain way to avoid this infection, and couples are encouraged to remain faithful in a mutually monogamous relationship with an uninfected partner.

References:

1. Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290:898-904.

2. Centers for Disease Control and Prevention. HPV Fact sheet. Atlanta: U.S. Department of Health and Human Services; 2010. Available at: http://www.cdc.gov/std/HPV/HPV-Factsheet-Nov-2011.pdf Accessed January 13, 2012.

3. Dunne EF, Unger ER, Sternberg M, et al. Prevalence of HPV infection among females in the United States. JAMA 2007;297:813-819.

4. Kuo H, Fujise K. Human papillomavirus and cardiovascular disease among U.S. women in the National Health and Nutrition Examination Survey, 2003 to 2006. J Am Coll Cardiol 2011;58:2001-2006.

5. Merched AJ, Williams E, Chan L. Macrophage-specific p53 expression plays a crucial role in atherosclerosis development and plaque remodeling. Arterioscler Thromb Vasc Biol 2003;23:1608-1614.

6. Boesten LS, Zadelaar AS, van Nieuwkoop A, et al. Macrophage retinoblastoma deficiency leads to enhanced atherosclerosis development in ApoE-deficient mice. FASEB J 2006;20:953-955.

Reviewed: February 2012

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