[The role of inflammation and infection in acute coronary syndrome].
INFLAMMATORY PROCESS: Within the vessel wall is considered to be crucial for initiation and progression of atherosclerosis. As response to endothelial injury a focal inflammatory response arises which can lead to plaque vulnerability and rupture and a consecutive acute coronary syndrome. Systemic markers of inflammation like C-reactive protein (CRP) or interleukin (IL) 6 are elevated in stable angina and acute coronary syndrome and are associated with future cardiovascular events even in initially healthy people. Alongside classical risk factors infectious agents like cytomegalovirus or Chlamydia pneumoniae are discussed to be involved in the local and systemic inflammatory response. Seroepidemiological studies revealed disparate results of the association between antibody titers against Chlamydia pneumoniae or cytomegalovirus and prevalence of coronary artery disease or future cardiovascular events. In animal models Chlamydia pneumoniae and cytomegalovirus increase accelerated neointimal response, however, molecular mechanisms are not entirely clear.


CONCLUSIONS
Whereas local and systemic inflammatory processes play a crucial role in atherogenesis and prognosis the causal role of infection in atherogenesis remains controversial.
Blankenberg
S
S
II. Medizinische Klinik, Johannes-Gutenberg-Universität Mainz. stefan.blankenberg@uni-mainz.de
Rupprecht
H J
HJ
Bickel
C
C
Hafner
G
G
Meyer
J
J
D000208:Acute Disease; D000787:Angina Pectoris / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D000789:Angina, Unstable / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D023521:Chlamydophila Infections / Q000150:complications; D016993:Chlamydophila pneumoniae; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D016207:Cytokines / Q000097:blood; D003586:Cytomegalovirus Infections / Q000150:complications; D006801:Humans; D007239:Infections / Q000150:complications*; D007249:Inflammation / Q000150:complications* / Q000175:diagnosis; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013577:Syndrome; D009626:Terminology as Topic
D000900:Anti-Bacterial Agents; D016207:Cytokines; D002097:C-Reactive Protein