The association of infection and coronary artery disease: an update

Numerous studies have reported an association of coronary atherosclerosis a nd restenosis with certain bacterial and viral infections. This article rev iews the pathophysiology of atherosclerosis, the role of infectious agents (cytomegalovirus, Chlamydia pneumoniae and Helicobacter pylori) in atheroge nesis and studies supporting the potential beneficial effects of antibiotic s or antiviral agents in the management of atherosclerotic disease. The int eractions of cytomegalovirus and the arterial wall have been extensively st udied. However, despite the successful preliminary therapeutic trials with the use of macrolides in augmenting possible C. pneumoniae-induced cardiova scular events, the exact mechanisms of how C. pneumoniae enters the arteria l wall remains unknown at this point. For H. pylori, regardless of the larg e number of studies performed to assess the association between H. pylori a nd coronary artery disease, no definitive conclusion could be made at this time, due to contradictory results. Before one can widely adopt the use of antibiotics or antiviral agents as treatment for atherosclerosis, further s tudies must be designed to address some important issues. In vivo animal mo dels need to be established to further examine the various hypotheses regar ding the interaction of infectious agents and atherosclerosis and restenosi s. Large-scale prospective cohort studies should be designed to relate evid ence of infection to future risk of cardiovascular diseases. Confounding va riables, such as other cardiovascular risk factors and socio-economic statu s, should be controlled in order to strengthen the association. Further int erventional studies are also required to establish the best antibiotic or a ntiviral regimen to maximise efficacy and minimise side effects.