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Chlamydia pneumoniae, antimicrobial therapy and coronary heart disease: a critical overview
1Department of Cardiological Sciences, St George's Hospital Medical School, London, UK. sgupta@sghms.ac.uk
Insights
Chlamydia pneumoniae infection may contribute to coronary heart disease (CHD), but its causal role and the effectiveness of antibiotic treatment for secondary prevention require further investigation through large-scale trials.
Area of Science:
- Infectious Diseases
- Cardiovascular Medicine
- Microbiology
Background:
- Traditional cardiovascular risk factors explain only half of coronary heart disease (CHD) prevalence and severity.
- Emerging evidence suggests a link between Chlamydia pneumoniae infection and atherosclerosis pathogenesis.
- This association is supported by seroepidemiological, pathological, and experimental studies.
Purpose of the Study:
- To investigate the potential causal role of Chlamydia pneumoniae in atherosclerosis.
- To evaluate the efficacy of anti-chlamydial antibiotics in the secondary prevention of CHD.
Main Methods:
- Review of seroepidemiological studies.
- Examination of pathological specimens.
- Laboratory experiments and animal models.
- Analysis of pilot intervention trials with antibiotics.
Main Results:
- Multiple lines of evidence suggest an association between Chlamydia pneumoniae and atherosclerotic diseases.
- The direct causal role of C. pneumoniae in atherosclerosis remains undetermined.
- The protective effect of antibiotics in secondary CHD prevention is not yet clear.
Conclusions:
- Further large-scale prospective antibiotic trials are necessary to clarify the role of Chlamydia pneumoniae in CHD.
- Antibiotic therapy's efficacy in secondary CHD prevention requires definitive evidence from ongoing studies.
Abstract:
Traditional cardiovascular risk factors, such as smoking, hypercholesterolaemia and hypertension probably only explain about 50% of the prevalence and severity of coronary heart disease (CHD). The recent interest in the association between Chlamydia pneumoniae and the pathogenesis and progression of atherosclerotic diseases is based on several lines of evidence-seroepidemiological studies, pathological specimen examinations, laboratory-based experiments, animal models and more recently, pilot intervention trials with anti-chlamydial antibiotics (Table 1). Whether C. pneumoniae has a direct causal role in atherosclerosis (and its clinical sequelae), and whether antibiotics have a protective role in the secondary prevention of CHD remains unclear. The results from large scale, prospective antibiotic trials in CHD, currently in progress, should help to clarify these important issues.