title: Increased incidence of Chlamydia species within the coronary arteries of patients with symptomatic atherosclerotic versus other forms of cardiovascular disease.
abstract: OBJECTIVE
  The objectives of this study were to test prospectively for an association between Chlamydia and atherosclerosis by comparing the incidence of the pathogen found within atherosclerotic plaques in patients undergoing directional coronary atherectomy with a variety of control specimens and comparing the clinical features between the groups.
  
  
  BACKGROUND
  Previous work has suggested an association between Chlamydia pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacteria within atherosclerotic tissue, but this association has not yet been regarded as established.
  
  
  METHODS
  Coronary specimens from 90 symptomatic patients undergoing coronary atherectomy were tested for the presence of Chlamydia species using direct immunofluorescence. Control specimens from 24 subjects without atherosclerosis (12 normal coronary specimens and 12 coronary specimens from cardiac transplant recipients with subsequent transplant-induced coronary disease) were also examined.
  
  
  RESULTS
  Coronary atherectomy specimens were definitely positive in 66 (73%) and equivocally positive in 5 (6%), resulting in 79% of specimens showing evidence for the presence of Chlamydia species within the atherosclerotic tissue. In contrast, only 1 (4%) of 24 nonatherosclerotic coronary specimens showed any evidence of Chlamydia. The statistical significance of this difference is a p value < 0.001. Transmission electron microscopy was used to confirm the presence of appropriate organisms in three of five positive specimens. No clinical factors except the presence of a primary nonrestenotic lesion (odds ratio 3.0, p = 0.057) predicted the presence of Chlamydia.
  
  
  CONCLUSIONS
  This high incidence of Chlamydia only in coronary arteries diseased by atherosclerosis suggests an etiologic role for Chlamydia infection in the development of coronary atherosclerosis that should be further studied.
authors.affiliation: Department of Medicine, University of Utah School of Medicine, LDS Hospital, Salt Lake City 84143, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Muhlestein
authors.forename: E H
authors.initials: EH
authors.lastname: Hammond
authors.forename: J F
authors.initials: JF
authors.lastname: Carlquist
authors.forename: E
authors.initials: E
authors.lastname: Radicke
authors.forename: M J
authors.initials: MJ
authors.lastname: Thomson
authors.forename: L A
authors.initials: LA
authors.lastname: Karagounis
authors.forename: M L
authors.initials: ML
authors.lastname: Woods
authors.forename: J L
authors.initials: JL
authors.lastname: Anderson
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary; D002689:Chlamydia / Q000302:isolation & purification*; D003324:Coronary Artery Disease / Q000382:microbiology* / Q000601:surgery; D003331:Coronary Vessels / Q000382:microbiology*; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006331:Heart Diseases / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies