IS THERE AN INFECTIVE ETIOLOGY TO ATHEROSCLEROSIS

Conventional cardiovascular risk factors fail to completely explain th e observed variations in the prevalence and severity of coronary heart disease (CHD). Common chronic infections may have an aetiological rol e in the development of atherosclerosis and CHD, either independently or by interacting with traditional atherogenic risk factors. The evide nce for Chlamydia pneumoniae as a potential causative agent is stronge st, and is based on findings of numerous sero-epidemiological studies, examination of atheromatous plaque specimens, in vitro animal models and, recently, pilot antichlamydial antibiotic intervention trials. Ho wever, the complete natural history of C. pneumoniae, its mechanisms o f damage in atherosclerotic disease, and the temporal sequence of infe ction and CHD remain unclear. Confirmation of true causality for the l ink between C. pneumoniae and CHD could come after the results of larg e-scale prospective antibiotic trials, which are to be conducted over the next few years. A proven association could have important implicat ions for public health worldwide, potentially leading to novel and rel atively inexpensive therapeutic measures in the secondary prevention o f CHD - broad-spectrum antibiotics.