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Multiple Infectious Agents and the Origins of Atherosclerotic Coronary Artery Disease
1School of Biotechnology and Biomolecular Sciences, University of New South Wales , Sydney, NSW , Australia.
Insights
Atherosclerotic coronary artery disease (ACAD) deaths have declined due to reduced coronary atheroma. This review hypothesizes infections in childhood initiate ACAD, with antibiotics and vaccines potentially lowering disease rates.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Epidemiology
Background:
- Atherosclerotic coronary artery disease (ACAD) remains a leading cause of death globally, despite a significant decline in recent decades.
- The etiology of ACAD is not fully understood, with traditional research focusing on the saturated fat hypothesis.
- Infectious agents are increasingly recognized as potential contributors to chronic diseases.
Purpose of the Study:
- To propose a novel hypothesis for the rise and fall of ACAD over the past century.
- To explore the role of infectious pathogens in the initiation of atherosclerosis, particularly in early life.
- To investigate the potential impact of public health interventions like antibiotics and vaccines on ACAD prevalence.
Main Methods:
- This review synthesizes existing evidence and proposes a working hypothesis.
- It examines historical trends in ACAD mortality and coronary atheroma prevalence.
- The review considers the potential influence of infectious disease dynamics and medical interventions.
Main Results:
- ACAD trends appear to correlate with changes in coronary atheroma prevalence.
- Infectious pathogens are hypothesized to initiate atherosclerosis during infancy and childhood.
- A decline in infectious diseases due to antibiotics and vaccines may explain the reduction in ACAD.
Conclusions:
- The prevalence of coronary atheroma, potentially initiated by childhood infections, is hypothesized to drive ACAD trends.
- Widespread antibiotic and vaccine use may be key factors in the recent decline of ACAD.
- Further research is warranted to validate the infectious etiology of atherosclerosis.
Abstract:
Although deaths due to atherosclerotic coronary artery disease (ACAD) have fallen dramatically during the past 50 years, ACAD remains as the leading cause of death in all continents, except Africa, where deaths due to infections are still dominant. Although food and nutrition have a proven role in atherosclerosis, the underlying causes of ACAD remain unknown. This is despite a century of intensive research dominated by investigations into the saturated fat hypothesis. In this review, it is hypothesized that the rise and fall in ACAD during the past 100 years is primarily due to the parallel rise and fall in the prevalence of coronary atheroma, the underlying disease. It is further hypothesized that infectious pathogens initiate atherosclerosis mainly during infancy and childhood. It is speculated that widespread use of antibiotics and vaccines against bacterial and viral infections may be the reason for the dramatic fall in coronary atheroma and ACAD during the past 50 years. The relevant evidence and a working hypothesis are included in this review.
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