INTERACTIVE ROLE OF INFECTION, INFLAMMATION AND TRADITIONAL RISK-FACTORS IN ATHEROSCLEROSIS AND CORONARY-ARTERY DISEASE

Although first suggested at the turn of the 20th century, there is a r enewed interest in the infectious theory of atherosclerosis. Studies d one in many laboratories around the world over the past several years have shown an association between markers of inflammation and coronary atherosclerosis with an exacerbation of the inflammatory process duri ng acute myocardial ischemia, particularly in the early stages of repe rfusion, It is also being recognized that the traditional risk factors , such as smoking, dyslipidemia, hypertension and diabetes mellitus, d o not explain the presence of coronary atherosclerosis in a large prop ortion of patients. We believe that in certain genetically susceptible people, infection with very common organisms, such as Chlamydia pneum oniae or cytomegalovirus, may lead to a localized infection and a chro nic inflammatory reaction. Persistence of infection may relate to the degree of inflammation and severity of atherosclerosis. Early trials w ith appropriate antibiotic agents in some patients with a recent histo ry of acute myocardial infarction have led to very salutary results. I f patients with an infectious basis of atherosclerosis can be identifi ed, a therapy directed at eradication of the offending organism may be appropriate.