The role of inflammation and infection in acute coronary syndrome

Inflammatory process within the vessel wall is considered to be crucial for initiation and progression of atherosclerosis. As response to endothelial injury a focal inflammatory response arises which can lead to plaque vulner ability and rupture and a consecutive acute coronary syndrome. Systemic mar kers of inflammation like C-reactive proteine (CRP) or interleukin (IL) 6 a re elevated in stable angina and acute coronary syndrome and are associated with future cardiovascular events even in initially healthy people. Alongs ide classical risk factors infectious agents like cytomegalovirus or Chlamy dia pneumoniae are discussed to be involved in the local and systemic infla mmatory response. Seroepidemiological studies revealed disparate results of the association between antibody titers against Chlamydia pneumoniae or cy tomegalovirus and prevalence of coronary artery disease or future cardiovas cular events. In animal models Chlamydia pneumoniae and cytomegalovirus inc rease accelerated neointimal response, however, molecular mechanisms are no t entirely clear. Conclusion: Whereas local and systemic inflammatory processes play a crucia l role in atherogenesis and prognosis the causal role of infection in ather ogenesis remains controversial.