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Chronic infections and atherosclerosis
1Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Infectious agents like Chlamydia pneumoniae may contribute to coronary heart disease (CHD) beyond traditional risk factors. Further research is needed to clarify the role of chronic infections and inflammation in atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Pathology
Background:
- Established risk factors for atherosclerosis do not fully explain coronary heart disease (CHD) epidemiology.
- Infectious agents are increasingly recognized as potential contributors to CHD development.
- Chronic infections may link inflammation and atherogenesis, influencing disease presentation.
Purpose of the Study:
- To investigate the role of infectious diseases as a risk factor for coronary heart disease (CHD).
- To explore the association between specific microorganisms (Chlamydia pneumoniae, Cytomegalovirus, Helicobacter pylori) and CHD.
- To understand how chronic infections contribute to the inflammatory processes in atherogenesis.
Main Methods:
- Review of epidemiological studies, pathology of atherosclerotic plaques, animal models, and molecular biology.
- Analysis of results from clinical antibiotic trials.
- Examination of the impact of chronic infection on T cell activation and plaque stability.
Main Results:
- Epidemiological, pathological, and molecular data suggest a positive association between Chlamydia pneumoniae infection and CHD.
- Chronic infections may destabilize atherosclerotic plaques by enhancing T cell activation.
- The precise pathophysiological mechanisms linking infections and CHD require further elucidation.
Conclusions:
- Chronic infections, particularly with Chlamydia pneumoniae, may play a significant role in the etiology of CHD.
- Inflammation driven by chronic infections is a key factor in atherogenesis.
- Future antibiotic intervention studies are crucial to confirm the role of infection and inflammation in CHD.
Abstract:
The established risk factors for atherosclerosis such as hypertension, smoking, diabetes mellitus, hyperlipidemia, and hyperhomocysteinemia do not explain clinical and epidemiological features of coronary heart disease (CHD). The role of infectious disease as a CHD risk factor may partly explain these features. Chronic infection with various microorganisms, particularly, Chlamydia pneumoniae, Cytomegalovirus (CMV) and Helicobacter pylori may play a role in etiological factors, linking inflammation and atherogenesis. Results from epidemiological studies, pathology of atherosclerotic plaques, animal studies, molecular biology and clinical antibiotic trials indicated a positive association between C. pneumoniae infection and CHD. Chronic infection might also influence preexisting plaque by enhancing T cell activation, which participate in destabilization of intimal cap. However, the exact nature of pathophysiological link between the organisms and CHD remains to be elucidated. Future antibiotic interventional studies may help to further clarify the role of chronic infection and inflammation in CHD.