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Weighing the evidence for infection as a risk factor for coronary heart disease
1Framingham Heart Study, 5 Thurber Street, Framingham, MA 01702, USA. chris@fram.nhlbi.nih.gov
Insights
Infections from pathogens like Chlamydia pneumoniae are hypothesized to cause coronary heart disease. However, current evidence is insufficient to confirm infection as a causal risk factor for atherosclerotic diseases.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Pathogen-Associated Atherosclerosis Research
Background:
- Investigating the role of infectious agents, including Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus, in the etiology of coronary heart disease (CHD) and other atherosclerotic diseases.
- Examining evidence linking pathogen presence in atherosclerotic plaques and systemic inflammation to coronary disease development.
Purpose of the Study:
- To evaluate the hypothesis that specific infections are a causal factor in coronary heart disease.
- To assess the current evidence supporting and refuting the link between chronic infections and atherosclerosis.
Main Methods:
- Review of studies localizing bacterial antigens to atherosclerotic plaques.
- Analysis of associations between systemic inflammation, chronic infections, and coronary disease.
- Evaluation of recent prospective follow-up studies on infection seropositivity and CHD.
Main Results:
- Some studies show positive associations between pathogen seropositivity and disease.
- Recent prospective studies have generally not supported these associations.
- Current evidence is insufficient to establish infection as a causal risk factor for CHD.
Conclusions:
- The hypothesis that infections cause coronary heart disease and atherosclerosis remains under investigation.
- Larger observational studies and antibiotic trials are needed to clarify the role of infection in CHD risk.
- Infection is not currently recognized as a causal risk factor beyond established coronary risk factors.
Abstract:
There has been considerable attention in recent years to the intriguing hypothesis that coronary heart disease and other atherosclerotic diseases may be caused by infection with pathogens such as Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus. Supporting this hypothesis are studies that localize bacterial antigens to atherosclerotic plaques and that draw associations of systemic inflammation and chronic infections with coronary disease. Although there are several examples of positive associations of pathogen seropositivity with disease, recent prospective follow-up studies of infection seropositivity have not generally supported these associations. At present, the evidence is insufficient to designate infection as a causal risk factor for coronary heart disease. The results of ongoing larger observational studies and antibiotic treatment trials may yield important information regarding the presence and magnitude of risk, if any, beyond that conferred by established coronary risk factors.