Infective endocarditis is an uncommon but serious disease, with a high morbidity and mortality. Because of its seriousness, and because of the high prevalence of some of its presumed risk factors, e.g., mitral valve prolapse and dental procedures, considerable effort and resources are expended on antibiotic prophylaxis intended to prevent its occurrence. In order to determine the validity of the assumptions about risk factors which underly the recommendations for these interventions, a case-control study is planned in the Delaware Valley. 300 hospitalized incident cases of endocarditis will be identified and matched by age and sex to a community control group. This comparison will be used to investigate host risk factors for endocarditis, especially mitral value prolapse. Then, for those cases with one of the more common cardiac lesions as host risk factors, a second control subject will be selected, matched for age, sex, and that particular cardiac lesion. This second comparison is expected to involve 150 of the cases and 150 new controls. This comparison will be used to determine whether certain antecedent procedures which might increase the risk of bacteremia, especially dental procedures, are in fact risk factors for developing endocarditis. All subjects will undergo a structured interview to obtain information on both host factors and procedures which could represent risk factors for endocarditis, and their medical and dental records will be reviewed for additional information and for validation of the interview data. Univariate analyses, including calculation of odds ratios and confidence intervals, will be followed by stratification and multiple logistic regression, enabling us to evaluate the relative importance of each variable as a risk factor. With this approach, we should be able to shed additional light on risk factors for this important and relatively unstudied disease. The current list of indications for antibiotic prophylaxis can then be refined, eliminating indications that are not true risk factors and adding others that are. Resources now being spent on prophylaxis can then be better focused.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL039000-01
Application #
3355511
Study Section
Epidemiology and Disease Control Subcommittee 3 (EDC)
Project Start
1987-09-01
Project End
1990-08-31
Budget Start
1987-09-01
Budget End
1988-08-31
Support Year
1
Fiscal Year
1987
Total Cost
Indirect Cost
Name
University of Pennsylvania
Department
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Landmesser, Ulf; Dikalov, Sergey; Price, S Russ et al. (2003) Oxidation of tetrahydrobiopterin leads to uncoupling of endothelial cell nitric oxide synthase in hypertension. J Clin Invest 111:1201-9
Strom, B L; Abrutyn, E; Berlin, J A et al. (2000) Risk factors for infective endocarditis: oral hygiene and nondental exposures. Circulation 102:2842-8
Strom, B L; Abrutyn, E; Berlin, J A et al. (1998) Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study. Ann Intern Med 129:761-9
Sekeres, M A; Abrutyn, E; Berlin, J A et al. (1997) An assessment of the usefulness of the Duke criteria for diagnosing active infective endocarditis. Clin Infect Dis 24:1185-90
Berlin, J A; Abrutyn, E; Strom, B L et al. (1995) Incidence of infective endocarditis in the Delaware Valley, 1988-1990. Am J Cardiol 76:933-6
Berlin, J A; Abrutyn, E; Strom, B L et al. (1994) Assessing diagnostic criteria for active infective endocarditis. Am J Cardiol 73:887-91