Joseph B Muhlestein MD

The Big Heart Disease Lie

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Contents

Introduction Chlamydia pneumoniae Helicobacter pylori Mycoplasma pneumoniae Cytomegalovirus Other Herpesviruses Human Immunodeficiency Virus Influenza Virus

Total Pathogen Burden as an Aggregate Serological Risk Factor

Clinical Use of Infectious Markers for Risk Stratification:

Not Yet Ready for Prime Time Conclusion References

Summary

Chronic infection has been found to be significantly associated with the development of atherosclerosis and the clinical complications of unstable angina, myocardial infarction, and stroke. A variety of infectious agents have been proposed to be involved in atherothrombosis, and, indeed, the number of implicated agents continues to increase each year. These include specific bacterial and viral agents, as well as a variety of agents associated with periodontal disease. However, failure to confirm initial reports of serological associations also has been common. The infectious agents with the most evidence to support an etiological role in atherosclerosis include Chlamydia pneumoniae and cytomegalovirus. In addition, evidence is mounting for a variety of other potential agents including other herpes viruses, influenza, other specific bacteria (such as Mycoplasma pneumoniae), and chronic infections with common bacterial agents (e.g., periodontal disease, chronic bronchitis, chronic urinary tract infection). Nevertheless, specific causative relationships on par with that determined between Helicobacter pylori and peptic ulcer disease have not yet been established. In addition, treatment of some of these pathogens

From: Contemporary Cardiology: Cardiovascular Biomarkers: Pathophysiology and Disease Management Edited by: David A. Morrow © Humana Press Inc., Totowa, NJ

has failed to reduce the risk of cardiovascular complications. Future studies are expected to elucidate further the pathophysiological relationship between chronic infection and atherosclerosis and the potential of a variety of treatment approaches including antibiotics. Until then, however, a general recommendation for the use of any of these infectious markers during routine cardiovascular risk stratification cannot be made.

Key Words: Infection; Chlamydia pneumoniae; Helicobacter pylori; Mycoplasma pneumoniae; cytomegalovirus; atherosclerosis.

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