Health impact of a hypothetical intervention on immune burden of cytomegalovirus (CMV) among older adults in the US: a prospective analysis of the Health and Retirement Study Cohort.

BACKGROUND: Cytomegalovirus (CMV) infection has been indicted in the etiology of multiple aging-related diseases. We aimed to quantify the proportion of diseases that could be prevented with a potential CMV treatment among US older individuals.

METHODS: We analyzed disease prevalence among 8934 eligible individuals from the US Health and Retirement Study (HRS) in 2016-2020. In our hypothetical intervention, the treatment would improve immune control of CMV and shift the distribution of continuous CMV IgG antibody levels from the highest quartile to the lower 3 quartiles. We estimated top-quartile CMV level attributable fractions for 7 outcomes: heart diseases, stroke, high blood pressure, high cholesterol, cancers, diabetes, and difficulty with Activities of Daily Living using a novel logistic regression-based approach which allows for continuous covariate adjustment for counterfactual prevalence, stratified by gender and race/ethnicity.

FINDINGS: In the study sample, a hypothetical intervention that decreased CMV IgG below the highest quartile level in 2016 would result in a 3·57 (95% Confidence Interval: 1·54, 5·60) percentage points reduction of diabetes cases and a 1·81 (95% CI: 0·75, 2·86) percentage points reduction of high blood pressure cases among Non-Hispanic White (NHW) women. Among NHW men, the same intervention would lead to a 2·43 (95% CI: 0·49, 4·37) percentage points reduction of diabetes, a 2·89 (95% CI: 0·93, 4·86) percentage points reduction of heart diseases and a 2·52 (95% CI: 1·39, 3·65) percentage points reduction of high blood pressure.

INTERPRETATION: Our findings provide initial evidence for the potential population health impact of CMV intervention, specifically on high blood pressure, diabetes, and heart diseases.

FUNDING: National Institutes of Health, National Institute on Aging.