Infection and atherosclerosis. An alternative view on an outdated hypothesis

Area of Science:

• Microbiology
• Cardiovascular Disease Research
• Infectious Disease Epidemiology

Background:

• Early 20th-century suggestions of microbial involvement in vascular diseases were largely unexplored until the late 1970s.
• Pioneering work and the association of Chlamydia pneumoniae with coronary heart disease significantly advanced research into the infection hypothesis.
• Numerous studies have since explored links between various pathogens and atherosclerosis, proposing molecular mechanisms.

Observation:

• A substantial body of evidence suggests a role for microbes in the development and progression of atherosclerosis.
• Molecular mechanisms explaining how pathogens might influence atherogenesis have been proposed.
• Recent large-scale randomized trials evaluating antibiotic treatment for secondary prevention of coronary events yielded no significant reduction in cardiovascular events.

Findings:

• Despite extensive research and proposed mechanisms, recent clinical trials challenge the direct causal role of microbial infections in atherosclerosis.
• The efficacy of antibiotic therapy in preventing cardiovascular events has not been demonstrated in large prospective trials.
• The validity of the infection hypothesis as a primary driver of atherosclerosis is seriously questioned by current clinical evidence.

Implications:

• The accumulated evidence supporting a microbial link to vascular disease should not be disregarded.
• Future research may need to explore alternative angles or mechanisms by which microbes influence atherogenesis.
• Re-evaluating the infection hypothesis may lead to novel therapeutic strategies beyond conventional antibiotic treatments.