Infectious Agents, Antibiotics, and Coronary Artery Disease

Atherosclerotic cardiovascular disease, the major cause of death in the Western world, is a multi-factorial process with a large number of interacting variables. Despite a significant understanding of many of these variables, the underlying causes of atherosclerosis are still not clearly defined. Recent studies have documented a possible association between chronic inflammation and a variety of chronic bacterial infections (including Chlamydia pneumoniae, Helicobacter pylori, and a variety of periodontal infectious agents) and the development or progression of atherosclerosis. Because these bacterial agents are sensitive to a variety of antibiotic agents, it has been proposed that antimicrobial therapy might be useful in the primary or secondary prevention of atherosclerosis. This article reviews the evidence supporting an association between chronic bacterial infection and atherosclerosis, describes the results of preliminary secondary prevention antibiotic treatment trials, and discusses a variety of ongoing and planned large multicenter clinical trials of antibiotics in patients with atherosclerotic heart disease. Potential pitfalls associated with the broad use of antibiotics to treat heart disease are also discussed.