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Human cytomegalovirus infection is associated with stroke in women: the US National Health and Nutrition Examination Survey 1999–2004
  1. Juanying Zhen1,2,
  2. Minyan Zeng1,
  3. Xiaodan Zheng1,2,
  4. Hongyan Qiu1,
  5. Bernard Man Yung Cheung3,4,
  6. Aimin Xu3,4,
  7. Jun Wu1,
  8. Chao Li1,3,4
  1. 1Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
  2. 2Department of Clinical Medicine, Shantou University Medical College, Shantou, Guangdong Province, China
  3. 3Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR
  4. 4State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Pokfulam, Hong Kong SAR
  1. Correspondence to Professor Chao Li; dcli{at}; Professor Jun Wu; wujun188{at}; Professor Bernard Man Yung Cheung; mycheung{at}


Background Increasing evidence indicated that infection factors play important roles in stroke development. Human cytomegalovirus (HCMV) infection was positively associated with atherosclerosis and hypertension which are stroke risk factors. Therefore, we aimed to explore the relationship between HCMV infection and stroke using the data of US National Health and Nutrition Examination Survey (NHANES).

Methods We analysed data on 2844 men and 3257 women in the NHANES 1999–2004. We included participants aged 20–49 years who had valid data on HCMV infection and stroke.

Results 54.1% of participants had serological evidence of HCMV infection and 0.8% of them had a previous diagnosis of stroke. There were ethnic differences in the prevalence of HCMV seropositivity (p<0.001). There was no significant association between HCMV seropositivity and stroke in men in any of the models. In women, HCMV seropositivity was associated with stroke before adjustment (OR=3.45, 95% CI 1.09 to 10.95, p=0.036). After adjusting for race/ethnicity, the association remained significant (OR=4.40, 95% CI 1.37 to 14.09, p=0.014). After further adjustment for body mass index, diabetes, hypercholesterolaemia, hypertension, alcohol consumption, smoking and physical activity, the association still existed (OR=3.58, 95% CI 1.14 to 11.25, p=0.030). The association was significant consistently in adjusted model for age (OR=3.39, 95% CI 1.08 to 10.64, p=0.037).

Conclusions We found a strong association between HCMV and stroke in women from the nationally representative population-based survey. This provide additional motivation for undertaking the difficult challenge to reduce the prevalence of stroke.

  • stroke
  • infection control

Statistics from


  • Contributors JZ and CL planned the study. JZ, MZ, XZ, HQ and CL analysed the data. JZ and MZ performed the literature search and wrote the paper. BC, AX, JW and CL made the critical revision of the paper. All authors have contributed significantly to the manuscript to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The data used to support the findings of this study are available from the corresponding author upon request.

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