[Is infection a pathogenetic factor in coronary heart disease?].
BACKGROUND
Several wellknown risk-factors can contribute to the development of coronary artery disease. A relatively new question is whether infection is also involved in the pathogenesis. Acute and/or chronic infections might affect initiation, progression and instability in coronary artery disease, as well as enhance development of restenosis and transplant atherosclerosis. In clinical studies it is possible to measure the amount of antibodies in blood samples, detect infectious agents in atheromatous lesions, and evaluate potential effects of antibiotic treatment. In animal models it is possible to investigate whether a direct infection can induce atheromatosis.


METHODS
The aim of this article is to give an updated overview of clinical and experimental results and discuss potential consequences for the treatment of coronary artery disease. Possible cellular mechanisms will be presented.


RESULTS
In conclusion, there is an association between coronary artery disease and infection with Chlamydia pneumoniae. Similar results are not obtained for infection with Helicobacter pylori. There is also an association between cytomegalovirus infection and development of restenosis and transplant atherosclerosis. However, a possible direct causal relationship is not fully established. Of special interest is whether antibiotic treatment can prevent acute cardiovascular events.


CONCLUSIONS
Primary prevention must still be targeted at conventional risk factors. However, in secondary prevention it can be valuable to identify subgroups of patients which may benefit from anti-infection treatment.
Sommerschild
H T
HT
Institutt for eksperimentell medisinsk forskning Ullevål sykehus 0407 Oslo. hilchen.sommerschild@ioks.uio.no
D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy; D018849:Controlled Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000150:complications / Q000382:microbiology / Q000821:virology; D003327:Coronary Disease / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control / Q000821:virology; D006801:Humans; D011446:Prospective Studies; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D014777:Virus Diseases / Q000150:complications*
D000900:Anti-Bacterial Agents