Slide 1
Slide 2+3
A number of chronic inflammatory diseases have been linked with
an infective aetiology - with varying degrees of evidence.
Atherosclerosis is now acknowledged as an inflammatory disease
and infection, at least in part, may play a role in its pathogenesis.
Slide 4
A number of infective agents have been associated with
atherosclerosis; greatest evidence for a "culprit" role
is for the respiratory pathogen, Chlamydia pneumoniae.
Slide 5+6
The mechanism by which Chlamydia pneumoniae may contribute to
athero-thrombosis and its clinical sequelae remains unclear.
A number of direct (eg. endothelial cell damage) and
indirect/modulation mechanism (eg. macrophage activation)
have been proposed.
Slide 7
Evidence to date has associated Chlamydia pneumoniae in coronary
heart disease through sero-epidemiological studies, pathological
specimen examinations, in vitro experiments, animal models,
analogies with other Chlamydial infections and preliminary
intervention studies (with antibiotics in CHD).
Slide 8+9
A number of (antichlamydial) antibiotic studies in a clinical
setting have been published,. Most show a benefit in reducing
infective markers, inflammation and clinical events. However,
almost all studies are clinically underpowered to have a
confirmatory answer of the role of the microorganism in CHD - or
the proven benefit of antibiotics in such a setting. There are
also a number of unresolved issues remaining, including concerns
of antibiotic resistance, duration of therapy and independent
antibiotic effects.
Slide 10+11
A number of large-scale, randomized prospective antibiotic trials
in CHD are hence underway. We hope to have results appearing
2002-2004. The meta-analyses of all such trials may (or may not)
eventually identify a subgroup of cardiac patients to benefit
from such novel therapy; this could have a major impact on
public health worldwide. At this juncture, however, we remain
focused on addressing the established risk factors for
CHD - cholesterol, cigarette smoking, hypertension, obesity
and diabetes mellitus.
