Inflammation, infection and antimicrobial therapy in coronary heart disease - where do we currently stand?

Traditional atherosclerotic risk factors such as hypertension, smoking, hyp erlipidaemia and diabetes mellitus, account for only about 50% of the clini cal occurrence of coronary heart disease (CHD), The infectious hypothesis p roposes that various microorganisms, in particular, Chlamydia pneumoniae, m ay serve as potential etiological factors, linking inflammation and atheros clerosis (or its clinical manifestations). Evidence from seroepidemiology, pathology, animal models, molecular biology and immunology, and human antib iotic intervention studies, collectively have suggested a largely positive association between C, pneumoniae infection and CHD. As CHD is a multifacto rial disease, it is possible that C. pneumoniae may interact with conventio nal cardiovascular risk factors and predispose certain genetically suscepti ble people to atherosclerotic disease. However, the precise nature of a cau sal or coincidental link between C. pneumoniae and CHD remains to be determ ined. The results of ongoing antibiotic intervention studies may help to fu rther clarify the role of infection and inflammation in CHD, but until such a role is proven beyond reasonable doubt, antimicrobial therapy cannot yet be justified in the treatment or prevention of CHD, A current perspective is presented in this review.