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The role of inflammation mechanisms in the pathogenesis and
progression of coronary artery disease (CAD) has been increasingly
discussed, but still remains unclear.
Seroepidemiological studies have suggested an association between atherosclerosis and chronic infection,
with most of the published studies referring to Chlamydia pneumoniae (Cpn)
Helicobacter pylori (Hp).[1-4]
The study von Sigh (Prospective analysis of the association of infection
with CagA bearing strains of Helicobacter pylori and coronary heart
disease“ Heart 2002;88: 43-46] showed an association between serological
status and development of atherosclerosis.
Recently we published our data with direct proof of Hp-DNA by PCR and
nucleotide sequence analysis in atherosclerotic coronary arteries. The
detection of Hp DNA but not serological findings was strongly associated
with clinical symptoms such as unstable angina and myocardial infarction.
In conclusion, the detection of Hp specific DNA in atheromatous plaque
material from coronary arteries and the strong association to the clinical
symptom of unstable angina could be interpreted as a direct involvement of
a Hp infection to the progression of pre-existent or concurrent CAD
induced by a local inflammatory process and subsequent local vascular
thrombosis. Similar to the gastric epithelial destruction Hp may cause a
direct endothelial damage of the arterial wall with subsequent plaque
instability by its toxic substances including proinflammatory cytokines
inclusive CagA cytotoxins, endotoxins, and others.
(1) 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.
(2) Glynn J. Helicobacter pylori and the heart. Lancet 1994;344:146.
(3) Gunn M, Stephens JC, Thompson JR, Rathbone BJ, Samani NJ. Significant
association of cagA positive Helicobacter pylori strains with risk of
premature myocardial infarction. Heart 2000;84:267-271
(4) Kowalski M, Konturek PC, Pieniazek P et al. Prevalence of Helicobacter
pylori infection in coronary artery disease and effect of its eradication
on coronary lumen reduction after percutaneous coronary angioplasty.
Digest Liver Dis 2001;3: 222-229.
(5) Singh RK, McMahon AD, Patel H, Packard CJ, Rathbone BJ, Samani NJ for
the West of Scotland Coronary Prevention Group: Prospective analysis of
the association of infection with CagA bearing strains of Helicobacter
pylori and coronary heart disease. Heart 2002; 88: 43-46
(6) Kowalski M, Rees W, Konturek PC, Grove R, Scheffold T, Maixner H,
Brunec M, Franz N, Konturek JW, Pieniazek P, Hahn EG, Konturek SJ, Thale
J, Warnecke H: Association of Helicobacter pylori specific DNA in human
atheromatous coronary arteries to prior myocardial infarction and unstable
angina. Digest Liver Dis 2002;34:398-402.