Cytomegalovirus and arterial disease: Present concepts.

The cytomegalovirus (CMV) is the only microbial agent implicated in three p articular types of arterial disease : coronary disease of the transplanted heart, postangioplasty restenosis and atherosclerosis. The object of this a rticle is to analyse the recent data on the role of CMV in these pathologie s with an exhaustive review of the literature. The available data is mainly epidemiological but the interpretation is diff icult because of the multiplicity and imperfections of the diagnostic techn iques of the infection. However, the results are quite concordant in favour of a real association. Different physiopathological mechanisms are propose d. In coronary disease of the transplanted heart, the lesions could be initiat ed by an inflammatory process. In post-angioplasty restenosis, the virus se ems able to trigger cellular proliferation by inhibiting the mechanisms of apoptosis. Finally, in atherosclerosis, CMV infection seems to promote athe rothrombotic processes and accelerate the progression of atherosclerotic pl aques by activating inflammatory cells. Direct methods of detection of vira l DNA show the presence of the virus within these lesions. There is, therefore, epidemiological, anatomo-pathological and physiopathol ogical evidence in favour of a relationship between CMV infection and these three forms of arterial disease.