Is there an infective aetiology to atherosclerosis?
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Updated: Oct 29, 2026
A Human Ex Vivo Atherosclerotic Plaque Model to Study Lesion Biology
Published on: May 6, 2014
1Department of Cardiological Sciences, St George's Hospital Medical School, London, England. sgupta@sghms.ac.uk
Insights
Chronic infections, particularly Chlamydia pneumoniae, may contribute to coronary heart disease (CHD) beyond traditional risk factors. Further antibiotic trials are needed to confirm causality and explore prevention strategies.
Area of Science:
- Infectious disease epidemiology
- Cardiovascular medicine
- Microbiology
Background:
- Traditional cardiovascular risk factors do not fully account for coronary heart disease (CHD) prevalence and severity.
- Chronic infections are increasingly investigated for their potential role in atherosclerosis and CHD development.
- Chlamydia pneumoniae is a leading candidate pathogen implicated in CHD etiology.
Purpose of the Study:
- To review the evidence linking Chlamydia pneumoniae infection to atherosclerosis and CHD.
- To discuss the potential mechanisms and remaining uncertainties regarding C. pneumoniae's role in CHD.
- To highlight the implications of a confirmed causal link for public health and secondary prevention.
Main Methods:
- Review of sero-epidemiological studies.
- Analysis of atheromatous plaque specimens.
- Examination of in vitro and animal models.
- Assessment of pilot antichlamydial antibiotic intervention trials.
Main Results:
- Substantial evidence suggests an association between C. pneumoniae and CHD.
- Pilot antibiotic trials show promise, but causality is not yet definitively established.
- Further research is required to elucidate the natural history and pathogenic mechanisms of C. pneumoniae in atherosclerotic disease.
Conclusions:
- Chlamydia pneumoniae is a strong candidate for an etiological role in CHD.
- Large-scale prospective antibiotic trials are crucial for confirming causality.
- A confirmed link could lead to novel secondary prevention strategies using antibiotics for CHD.
Abstract:
Conventional cardiovascular risk factors fail to completely explain the observed variations in the prevalence and severity of coronary heart disease (CHD). Common chronic infections may have an aetiological role in the development of atherosclerosis and CHD, either independently or by interacting with traditional atherogenic risk factors. The evidence for Chlamydia pneumoniae as a potential causative agent is strongest, and is based on findings of numerous sero-epidemiological studies, examination of atheromatous plaque specimens, in vitro animal models and, recently, pilot antichlamydial antibiotic intervention trials. However, the complete natural history of C. pneumoniae, its mechanisms of damage in atherosclerotic disease, and the temporal sequence of infection and CHD remain unclear. Confirmation of true causality for the link between C. pneumoniae and CHD could come after the results of large-scale prospective antibiotic trials, which are to be conducted over the next few years. A proven association could have important implications for public health worldwide, potentially leading to novel and relatively inexpensive therapeutic measures in the secondary prevention of CHD--broad-spectrum antibiotics.
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