Furthermore, data from the Danish Nationwide Cohort Study indicate that RA increases the rates of bothAF (incidence rate ratio, 1.42) and stroke (1.32),852 but a causal relationship between AF and stroke in RA has not been established. Patients with SLE had very elevated RRs for CVD in the 2- to 52-fold Although stroke rates were not assessed, several stud- ies have identified higher prevalence rates of atherosclerotic plaques in the carotid arteries in RA or SLE patients compared with control subjects.854 856 Patients with RA and SLE might be considered a subgroup at high risk for CVD worthy of enhanced risk factor measurement and control.857 Chronic infections such as periodontitis, chronic bronchitis, and infection with Helicobacter pylori, Chlamydia pneumoniae, or cytomegalovirus might promote atherosclerosis and increase the risk of stroke.858 There is evidence that the cumulative effect of multiple infections, or infectious burden, rather than single organisms, may be associated with risk of stroke and carotid Unfortunately, several randomized trials of antibiotic therapy have failed to find any benefit in the preven- tion of cardiovascular end points, including stroke.861,862 A final issue in the role of infection and inflammation in stroke relates to acute infectious diseases (such as influenza). Possible mechanisms include the induction of procoagulant acute-phase reactants (such as fibrinogen) or destabiliza- tion of atherosclerotic plaques. Hospitalization for infection appears to be a short-term risk factor for stroke,863 although it is unclear what, if any, management implications this has for patients. 