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[Is infection a pathogenetic factor in coronary heart disease?]
1Institutt for eksperimentell medisinsk forskning, Ullevål sykehus, 0407 Oslo. hilchen.sommerschild@ioks.uio.no
Insights
Infection with Chlamydia pneumoniae and cytomegalovirus is associated with coronary artery disease, restenosis, and transplant atherosclerosis. Further research is needed to confirm causality and explore antibiotic treatment benefits for cardiovascular events.
Area of Science:
- Investigates the role of infectious agents in cardiovascular diseases.
- Focuses on the pathogenesis of coronary artery disease, restenosis, and transplant atherosclerosis.
Context:
- Coronary artery disease (CAD) has well-known risk factors, but the role of infection in its development is a growing area of research.
- Infections may influence the initiation, progression, and instability of CAD, as well as restenosis and transplant atherosclerosis.
Purpose:
- To provide an updated overview of clinical and experimental findings on the link between infection and coronary artery disease.
- To discuss potential cellular mechanisms and implications for treating CAD.
- To evaluate the potential benefits of antibiotic treatment in managing cardiovascular events.
Summary:
- Clinical studies show an association between CAD and Chlamydia pneumoniae infection, and between cytomegalovirus infection and restenosis/transplant atherosclerosis.
- No similar association was found for Helicobacter pylori infection.
- A direct causal relationship between these infections and cardiovascular conditions remains to be fully established.
Impact:
- Findings suggest that while primary prevention of CAD should focus on conventional risk factors, identifying patient subgroups that may benefit from anti-infection treatment could be valuable in secondary prevention.
- Highlights the need for further investigation into the causal role of specific infections in cardiovascular disease.
- Opens avenues for exploring novel therapeutic strategies involving antibiotic treatments for specific patient populations at risk for cardiovascular events.
Background:
Several wellknown risk-factors can contribute to the development of coronary artery disease. A relatively new question is whether infection is also involved in the pathogenesis. Acute and/or chronic infections might affect initiation, progression and instability in coronary artery disease, as well as enhance development of restenosis and transplant atherosclerosis. In clinical studies it is possible to measure the amount of antibodies in blood samples, detect infectious agents in atheromatous lesions, and evaluate potential effects of antibiotic treatment. In animal models it is possible to investigate whether a direct infection can induce atheromatosis.
Material And Methods:
The aim of this article is to give an updated overview of clinical and experimental results and discuss potential consequences for the treatment of coronary artery disease. Possible cellular mechanisms will be presented.
Results:
In conclusion, there is an association between coronary artery disease and infection with Chlamydia pneumoniae. Similar results are not obtained for infection with Helicobacter pylori. There is also an association between cytomegalovirus infection and development of restenosis and transplant atherosclerosis. However, a possible direct causal relationship is not fully established. Of special interest is whether antibiotic treatment can prevent acute cardiovascular events.
Interpretation:
Primary prevention must still be targeted at conventional risk factors. However, in secondary prevention it can be valuable to identify subgroups of patients which may benefit from anti-infection treatment.