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The association of infection and coronary artery disease: an update
1Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
Insights
Infectious agents like cytomegalovirus, Chlamydia pneumoniae, and Helicobacter pylori may play a role in atherosclerosis. Further research is needed to confirm the efficacy of antibiotics and antiviral agents in treating cardiovascular disease.
Area of Science:
- Cardiovascular Research
- Infectious Diseases
- Pathophysiology
Background:
- Coronary atherosclerosis and restenosis are linked to bacterial and viral infections.
- Infectious agents such as cytomegalovirus, Chlamydia pneumoniae, and Helicobacter pylori are implicated in atherogenesis.
- Preliminary trials suggest potential benefits of antibiotics/antivirals in managing atherosclerotic disease.
Purpose of the Study:
- To review the pathophysiology of atherosclerosis.
- To examine the role of specific infectious agents in atherogenesis.
- To evaluate studies on the use of antibiotics and antiviral agents for atherosclerotic disease.
Main Methods:
- Literature review of studies on atherosclerosis and infections.
- Analysis of research on cytomegalovirus, Chlamydia pneumoniae, and Helicobacter pylori.
- Examination of therapeutic trials involving antibiotics and antivirals.
Main Results:
- Cytomegalovirus interactions with the arterial wall are well-studied.
- Chlamydia pneumoniae's entry mechanisms into the arterial wall remain unclear despite positive macrolide trials.
- Studies on Helicobacter pylori and coronary artery disease yield contradictory results, preventing definitive conclusions.
Conclusions:
- The exact role of infectious agents in atherosclerosis requires further investigation.
- Antibiotic and antiviral therapies for atherosclerosis need more robust evidence.
- Future research should focus on in vivo models, large prospective studies, and controlled interventional trials.
Abstract:
Numerous studies have reported an association of coronary atherosclerosis and restenosis with certain bacterial and viral infections. This article reviews the pathophysiology of atherosclerosis, the role of infectious agents (cytomegalovirus, Chlamydia pneumoniae and Helicobacter pylori) in atherogenesis and studies supporting the potential beneficial effects of antibiotics or antiviral agents in the management of atherosclerotic disease. The interactions of cytomegalovirus and the arterial wall have been extensively studied. However, despite the successful preliminary therapeutic trials with the use of macrolides in augmenting possible C. pneumoniae-induced cardiovascular events, the exact mechanisms of how C. pneumoniae enters the arterial wall remains unknown at this point. For H. pylori, regardless of the large number of studies performed to assess the association between H. pylori and coronary artery disease, no definitive conclusion could be made at this time, due to contradictory results. Before one can widely adopt the use of antibiotics or antiviral agents as treatment for atherosclerosis, further studies must be designed to address some important issues. In vivo animal models need to be established to further examine the various hypotheses regarding the interaction of infectious agents and atherosclerosis and restenosis. Large-scale prospective cohort studies should be designed to relate evidence of infection to future risk of cardiovascular diseases. Confounding variables, such as other cardiovascular risk factors and socio-economic status, should be controlled in order to strengthen the association. Further interventional studies are also required to establish the best antibiotic or antiviral regimen to maximise efficacy and minimise side effects.