The role of inflammation and infection in coronary artery disease

New insights into atherosclerosis, the most common disease affecting corona ry arteries, may change therapeutic strategies from largely symptomatic to causal. Atherosclerotic plaques contain a lipid-related, immune-mediated in flammation, with release of secretory products capable of changing plaque m orphology. Plaques prone to complications contain large numbers of inflamma tory cells; stable plaques contain little inflammation. Similarly, atherect omy specimens from patients with coronary syndromes revealed more inflammat ory cells in unstable than in stable patients. These observations, and the fact that acute coronary syndromes are associated with increased blood leve ls of inflammatory markers, have renewed interest in the possible relations hip between infection and atherogenesis. Of all potential candidate antigen s, Chlamydia pneumoniae presently is considered the most likely because a s ubstantial number of patients with unstable syndromes contain C. pneumoniae -reactive T cells, both in blood and within the atherosclerotic plaque, sug gesting enhancement of intraplaque inflammation.