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Infectious Diseases in the Etiology of Atherosclerosis and Acute Coronary Syndromese

Focus on Chlamydia pneumoniae

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Cardiac Markers

Part of the book series: Pathology and Laboratory Medicine ((PLM))

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Abstract

Several infectious agents including Herpes simplex virus, Cytomegalovirus, Helicobacter pylori, and Chlamydia pneumoniae have been investigated with respect to their role in the genesis of atherosclerosis. Although the increasing number of articles published on this issue suggests a causal role of infectious agents, the matter is far from settled and yet not proven.

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References

  1. Libby P, Egan D, Skarlatos S. Roles of Infectious Agents in Atherosclerosis and Restenosis:an Assessment of the Evidence and Need for Future Research. Circulation 1997; 96: 4095–4103.

    Article  PubMed  CAS  Google Scholar 

  2. Danesh J, Collins R, Peto R. Chronic infections and coronary heart disease: is there a link? Lancet 1997; 350: 430–436.

    Article  PubMed  CAS  Google Scholar 

  3. Ridker PM, Hennekens CH, Stampfer MJ, Wang F. Prospective Study of Herpes Simplex Virus, Cytomegalovirus, and the Risk of Future Myocardial Infarction and Stroke. Circulation 1998; 98: 2796–2799.

    Article  PubMed  CAS  Google Scholar 

  4. Borgia MC, Mandolini C, Barresi C, Battisti G, Carletti F, Capobianchi MR. Further evidence against the implication of active cytomegalovirus infection in vascular atherosclerotic diseases. Atherosclerosis 2001; 157: 457–462.

    Article  PubMed  CAS  Google Scholar 

  5. Hernandez D, Hanson E, Kasiske MK, Danielson B, Roel J, Kasiske BL. Cytomegalovirus disease is not a major risk factor for ischemic heart disease after renal transplantation 1. Transplantation 2001; 72: 1395–1399.

    Article  PubMed  CAS  Google Scholar 

  6. Ridker PM, Danesh J, Youngman L, Collins R, Stampfer MJ, Peto R, Hennekens CH. A prospective study of Helicobacter pylori seropositivity and the risk for future myocardial infarction among socioeconomically similar U.S. men. Ann Intern Med 2001; 135: 184–188.

    Article  PubMed  CAS  Google Scholar 

  7. Hoffmeister A, Rothenbacher D, Bode G, Persson K, Marz W, Nauck MA, Brenner H, Hombach V, Koenig W. Current infection with Helicobacter pylori, but not seropositivity to Chlamydia pneumoniae or cytomegalovirus, is associated with an atherogenic, modified lipid profile. Arterioscler Thromb Vasc Biol 2001; 21: 427–432.

    Article  PubMed  CAS  Google Scholar 

  8. Hara K, Morita Y, Kamihata H, Iwasaka T, Takahashi H. Evidence for infection with Helicobacter pylori in patients with acute myocardial infarction. Clin Chim Acta 2001; 313: 87–94.

    Article  PubMed  CAS  Google Scholar 

  9. Danesh J, Whincup P, Walker M, Lennon L, Thomson A, Appleby P, Wong Y, BernardesSilva M, Ward M. Chlamydia pneumoniae IgG titres and coronary heart disease: prospective study and meta-analysis. BMJ 2000; 321: 208–213.

    Google Scholar 

  10. West R. Commentary:adjustment for potential confounders may have been taken too far. BMJ 2000; 321: 213.

    Google Scholar 

  11. Gattone M, Iacoviello L, Colombo M, Castelnuovo AD, Soffiantino F, Gramoni A, Picco D, Benedetta M, Giannuzzi P. Chlamydia pneumoniae and cytomegalovirus seropositivity, inflammatory markers, and the risk of myocardial infarction at a young age. Am Heart J 2001; 142: 633–640.

    Article  PubMed  CAS  Google Scholar 

  12. Ridker PM, Kundsin RB, Stampfer MJ, Poulin S, Hennekens CH. Prospective Study of Chlamydia pneumoniae IgG Seropositivity and Risks of Future Myocardial Infarction. Circulation 1999; 99: 1161–1164.

    Article  PubMed  CAS  Google Scholar 

  13. Saikku P, Leinonen M, Mattila K, Ekman MR, Nieminen MS, Makela PH, Huttunen JK, Valtonen V. Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction. Lancet 1988; 2: 983–986.

    Article  PubMed  Google Scholar 

  14. Thom DH, Wang SP, Grayston JT, Siscovick DS, Stewart DK, Kronmal RA, Weiss NS. Chlamydia pneumoniae strain TWAR antibody and angiographically demonstrated coronary artery disease. Arterioscler Thromb 1991; 11: 547–551.

    Article  PubMed  CAS  Google Scholar 

  15. Saikku P, Leinonen M, Tenkanen L, Linnanmaki E, Ekman MR, Manninen V, Manttari M, Frick MH, Huttunen JK. Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study. Ann Intern Med 1992; 116: 273–278.

    Article  PubMed  CAS  Google Scholar 

  16. Thom DH, Grayston JT, Siscovick DS, Wang SP, Weiss NS, Daling JR. Association of prior infection with Chlamydia pneumoniae and angiographically demonstrated coronary artery disease. JAMA 1992; 268: 68–72.

    Google Scholar 

  17. Melnick SL, Shahar E, Folsom AR, Grayston JT, Sorlie PD, Wang SP, Szklo M. Past infection by Chlamydia pneumoniae strain TWAR and asymptomatic carotid atherosclerosis. Atherosclerosis Risk in Communities (ARIC) Study Investigators. Am J Med 1993; 95: 499–504.

    Article  PubMed  CAS  Google Scholar 

  18. Dahlen GH, Boman J, Birgander LS, Lindblom B. Lp(a) lipoprotein, IgG, IgA and IgM antibodies to Chlamydia pneumoniae and HLA class II genotype in early coronary artery disease. Atherosclerosis 1995; 114: 165–174.

    Article  PubMed  CAS  Google Scholar 

  19. Nieto FJ, Folsom AR, Sorlie PD, Grayston JT, Wang SP, Chambless LE. Chlamydia pneumoniae infection and incident coronary heart disease: the Atherosclerosis Risk in Communities Study. Am J Epidemiol 1999; 150: 149–156.

    Article  PubMed  CAS  Google Scholar 

  20. Siscovick DS, Schwartz SM, Corey L, Grayston JT, Ashley R, Wang SP, Psaty BM, Tracy RP, Kuller LH, Kronmal RA. Chlamydia pneumoniae, herpes simplex virus type 1, and cytomegalovirus and incident myocardial infarction and coronary heart disease death in older adults: the Cardiovascular Health Study. Circulation 2000; 102: 2335–2340.

    Article  PubMed  CAS  Google Scholar 

  21. Chandra HR, Choudhary N, O’Neill C, Boura J, Timmis GC, O’Neill WW. Chlamydia pneumoniae exposure and inflammatory markers in acute coronary syndrome (CIMACS). Am J Cardiol 2001; 88: 214–218.

    Article  PubMed  CAS  Google Scholar 

  22. Rupprecht HJ, Blankenberg S, Bickel C, Rippin G, Hafner G, Prellwitz W, Schlumberger W, Meyer J. Impact of viral and bacterial infectious burden on long-term prognosis in patients with coronary artery disease. Circulation 2001; 104: 25–31.

    Article  PubMed  CAS  Google Scholar 

  23. Zhu J, Nieto FJ, Home BD, Anderson JL, Muhlestein JB, Epstein SE. Prospective study of pathogen burden and risk of myocardial infarction or death. Circulation 2001; 103: 45–51.

    Article  PubMed  CAS  Google Scholar 

  24. Kuo CC, Shor A, Campbell LA, Fukushi H, Patton DL, Grayston JT. Demonstration of Chlamydia pneumoniae in atherosclerotic lesions of coronary arteries. J Infect Dis 1993; 167: 841–849.

    Article  PubMed  CAS  Google Scholar 

  25. Kuo CC, Gown AM, Benditt EP, Grayston JT. Detection of Chlamydia pneumoniae in aortic lesions of atherosclerosis by immunocytochemical stain. Arterioscler Thromb 1993; 13: 1501–1504.

    Article  PubMed  CAS  Google Scholar 

  26. Bauriedel G, Andrie R, Likungu JA, Welz A, Braun P, Welsch U, Luderitz B. Persistence of Chlamydia pneumoniae in coronary plaque tissue. A contribution to infection and immune hypothesis in unstable angina pectoris. Dtsch Med Wochenschr 1999; 124: 1408–1413.

    Article  PubMed  CAS  Google Scholar 

  27. Bauriedel G, Welsch U, Likungu JA, Welz A, Luderitz B. Chlamydia pneumoniae in coronary plaques: Increased detection with acute coronary syndrome. Dtsch Med Wochenschr 1999; 124: 375–380.

    Article  PubMed  CAS  Google Scholar 

  28. Blasi F, Denti F, Erba M, Cosentini R, Raccanelli R, Rinaldi A, Fagetti L, Esposito G, Ruberti U, Allegra L. Detection of Chlamydia pneumoniae but not Helicobacter pylori in atherosclerotic plaques of aortic aneurysms. J Clin Microbiol 1996; 34: 2766–2769.

    PubMed  CAS  Google Scholar 

  29. Juvonen J, Laurila A, Juvonen T, Alakarppa H, Surcel HM, Lounatmaa K, Kuusisto J, Saikku P. Detection of Chlamydia pneumoniae in human nonrheumatic stenotic aortic valves. J Am Coll Cardiol 1997; 29: 1054–1059.

    Article  PubMed  CAS  Google Scholar 

  30. Juvonen J, Juvonen T, Laurila A, Alakarppa H, Lounatmaa K, Surcel HM, Leinonen M, Kairaluoma MI, Saikku P. Demonstration of Chlamydia pneumoniae in the walls of abdominal aortic aneurysms. J Vasc Surg 1997; 25: 499–505.

    Article  PubMed  CAS  Google Scholar 

  31. Ramirez JA. Isolation of Chlamydia pneumoniae from the coronary artery of a patient with coronary atherosclerosis. The Chlamydia pneumoniae/Atherosclerosis Study Group. Ann Intern Med 1996; 125: 979–982.

    Article  PubMed  CAS  Google Scholar 

  32. Jantos CA, Nesseler A, Waas W, Baumgartner W, Tillmanns H, Haberbosch W. Low prevalence of Chlamydia pneumoniae in atherectomy specimens from patients with coronary heart disease. Clin Infect Dis 1999; 28: 988–992.

    Article  PubMed  CAS  Google Scholar 

  33. Grayston JT. Antibiotic Treatment Trials for Secondary Prevention of Coronary Artery Disease Events. Circulation 1999; 99: 1538–1539.

    Article  PubMed  CAS  Google Scholar 

  34. Maass M, Bartels C, Engel PM, Mamat U, Sievers HH. Endovascular presence of viable Chlamydia pneumoniae is a common phenomenon in coronary artery disease. J Am Coll Cardiol 1998; 31: 827–832.

    Article  PubMed  CAS  Google Scholar 

  35. Ross R. Atherosclerosis-An Inflammatory Disease. N Engl J Med 1999; 340: 115–126.

    Article  PubMed  CAS  Google Scholar 

  36. Zeiher AM. Endothelial vasodilator dysfunction: pathogenetic link to myocardial ischaemia or epiphenomenon? Lancet 1996; 348 (Suppl 1): s10 - s12.

    Article  PubMed  CAS  Google Scholar 

  37. Strong JP, Malcom GT, McMahan CA, Tracy RE, Newman WP, III, Herderick EE, Comhill JF. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA 1999; 281: 727–735.

    Google Scholar 

  38. Torzewski M, Rist C, Mortensen RF, Zwaka TP, Bienek M, Waltenberger J, Koenig W, Schmitz G, Hombach V, Torzewski J. C-reactive protein in the arterial intima: role of C-reactive protein receptor-dependent monocyte recruitment in atherogenesis. Arterioscler Thromb Vasc Biol 2000; 20: 2094–2099.

    Article  PubMed  CAS  Google Scholar 

  39. Kerner T, Ahlers O, Reschreiter H, Buhrer C, Mockel M, Gerlach H. Adhesion molecules in different treatments of acute myocardial infarction. Crit Care 2001; 5: 145–150.

    Article  PubMed  CAS  Google Scholar 

  40. Koenig W, Sund M, Frohlich M, Fischer HG, Lowel H, Doring A, Hutchinson WL, Pepys MB. C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation 1999;99:237–242.

    Google Scholar 

  41. Möckel M, Heller G, Jr., Müller C, Klefisch FR, Riehle M, Searle J, Frei U, Strachan DP. C-reactive protein as an independent marker of prognosis in acute coronary syndrome: comparison with troponin T. Z Kardiol 2000; 89: 658–666.

    Article  PubMed  Google Scholar 

  42. Heeschen C, Hamm CW, Bruemmer J, Simoons ML. Predictive value of C-reactive protein and troponin T in patients with unstable angina:a comparative analysis. CAPTURE Investigators. Chimeric c7E3 AntiPlatelet Therapy in Unstable angina REfractory to standard treatment trial. J Am Coll Cardiol 2000; 35: 1535–1542.

    Article  PubMed  CAS  Google Scholar 

  43. Biasucci LM, Liuzzo G, Grillo RL, Caligiuri G, Rebuzzi AG, Buffon A, Summaria F, Ginnetti F, Fadda G, Maseri A. Elevated levels of C-reactive protein at discharge in patients with unstable angina predict recurrent instability. Circulation 1999; 99: 855–860.

    Article  PubMed  CAS  Google Scholar 

  44. Ridker PM, Rifai N, Pfeffer MA, Sacks F, Braunwald E. Long-term effects of pravastatin on plasma concentration of C-reactive protein. The Cholesterol and Recurrent Events (CARE) Investigators. Circulation 1999; 100: 230–235.

    Article  PubMed  CAS  Google Scholar 

  45. Ridker PM, Rifai N, Clearfield M, Downs JR, Weis SE, Miles JS, Gotto AMJ. Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med 2001; 344: 1959–1965.

    Article  PubMed  CAS  Google Scholar 

  46. Ridker PM, Rifai N, Lowenthal SP. Rapid reduction in C-reactive protein with cerivastatin among 785 patients with primary hypercholesterolemia. Circulation 2001; 103 (9): 1191–1193.

    Article  PubMed  CAS  Google Scholar 

  47. Albert MA, Danielson E, Rifai N, Ridker PM. Effect of statin therapy on C-reactive protein levels: the pravastatin inflammation/CRP evaluation (PRINCE):a randomized trial and cohort study. JAMA 2001; 286: 64–70.

    Google Scholar 

  48. Momiyama Y, Hirano R, Taniguchi H, Nakamura H, Ohsuzu F. Effects of interleukin-1 gene polymorphisms on the development of coronary artery disease associated with Chlamydia pneumoniae infection. J Am Coll Cardiol 2001; 38: 712–717.

    Article  PubMed  CAS  Google Scholar 

  49. Dechend R, Maass M, Gieffers J, Dietz R, Scheidereit C, Leutz A, Gulba DC. Chlamydia pneumoniae infection of vascular smooth muscle and endothelial cells activates NF-kappaB and induces tissue factor and PAI-1 expression:a potential link to accelerated arteriosclerosis. Circulation 1999; 100: 1369–1373.

    Article  PubMed  CAS  Google Scholar 

  50. Laitinen K, Laurila A, Pyhala L, Leinonen M, Saikku P. Chlamydia pneumoniae infection induces inflammatory changes in the aortas of rabbits. Infect Immun 1997; 65: 48324835.

    Google Scholar 

  51. Fong IW, Chiu B, Viira E, Fong MW, Jong D, Mahony J. Rabbit model for Chlamydia pneumoniae infection. J Clin Microbiol 1997; 35: 48–52.

    PubMed  CAS  Google Scholar 

  52. Muhlestein JB, Anderson JL, Hammond EH, Zhao L, Trehan S, Schwobe EP, Carlquist JF. Infection with Chlamydia pneumoniae accelerates the development of atherosclerosis and treatment with azithromycin prevents it in a rabbit model. Circulation 1998; 97: 633–636.

    Article  PubMed  CAS  Google Scholar 

  53. Moazed TC, Campbell LA, Rosenfeld ME, Grayston JT, Kuo CC. Chlamydia pneumoniae infection accelerates the progression of atherosclerosis in apolipoprotein E-deficient mice. J Infect Dis 1999; 180: 238–241.

    Article  PubMed  CAS  Google Scholar 

  54. Gupta S, Leatham EW, Carrington D, Mendall MA, Kaski JC, Camm AJ. Elevated Chlamydia pneumoniae antibodies, cardiovascular events, and azithromycin in male survivors of myocardial infarction. Circulation 1997; 96: 404–407.

    Article  PubMed  CAS  Google Scholar 

  55. Gurfinkel E, Bozovich G, Daroca A, Beck E, Mautner B. Randomised trial of roxithromycin in non-Q-wave coronary syndromes: ROXIS Pilot Study. ROXIS Study Group. Lancet 1997; 350: 404–407.

    CAS  Google Scholar 

  56. Gurfinkel E, Bozovich G, Beck E, Testa E, Livellara B, Mautner B. Treatment with the antibiotic roxithromycin in patients with acute non-Q-wave coronary syndromes. The final report of the ROXIS Study. Eur Heart J 1999; 20: 121–127.

    Article  PubMed  CAS  Google Scholar 

  57. Muhlestein JB, Anderson JL, Carlquist JF, Salunkhe K, Horne BD, Pearson RR, Bunch T.1, Allen A, T.ehan S, Nielson C. Randomized secondary prevention trial of azithromycin in patients with coronary artery disease: primary clinical results of the ACADEMIC study. Circulation 2000; 102: 1755–1760.

    CAS  Google Scholar 

  58. Neumann F, Kastrati A, Miethke T, Pogatsa-Murray G, Mehilli J, Valina C, Jogethaei N, da Costa CP, Wagner H, Schomig A. Treatment of Chlamydia pneumoniae infection with roxithromycin and effect on neointima proliferation after coronary stent placement (ISAR3):a randomised, double-blind, placebo-controlled trial. Lancet 2001; 357: 2085–2089.

    Article  PubMed  CAS  Google Scholar 

  59. Jackson LA, Smith NL, Heckbert SR, Grayston JT, Siscovick DS, Psaty BM. Past use of erythromycin, tetracycline, or doxycycline is not associated with risk of first myocardial infarction. J Infect Dis 2000; 181 (Suppl 3): S563 — S565.

    Article  PubMed  CAS  Google Scholar 

  60. Dunne MW. Rationale and design of a secondary prevention trial of antibiotic use in patients after myocardial infarction: the WIZARD (weekly intervention with zithromax [azithromycin] for atherosclerosis and its related disorders) trial. J Infect Dis 2000; 181 (Suppl 3): S572 — S578.

    Article  PubMed  CAS  Google Scholar 

  61. Möckel M. Persistence of Chlamydia pneumoniae in coronary plaque tissue. Dtsch Med Wochenschr 2000; 125: 645.

    PubMed  Google Scholar 

  62. Gieffers J, Fullgraf H, Jahn J, Klinger M, Dalhoff K, Katus HA, Solbach W, Maass M. Chlamydia pneumoniae Infection in Circulating Human Monocytes Is Refractory to Antibiotic Treatment. Circulation 2001; 103: 351–356.

    Article  PubMed  CAS  Google Scholar 

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Möckel, M. (2003). Infectious Diseases in the Etiology of Atherosclerosis and Acute Coronary Syndromese. In: Wu, A.H.B. (eds) Cardiac Markers. Pathology and Laboratory Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-385-9_27

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  • DOI: https://doi.org/10.1007/978-1-59259-385-9_27

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-319-0

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