• heart disease

To the Editor

We would like to thank Professor Abdoli and Professor Rasti1 for their comments and interest in our article,2 and the editors of Heart for giving us the opportunity to reply.

The purpose of our recently published review on cardiac manifestations of parasitic disease2 was to update the current knowledge on the major heart diseases caused by protozoa and helminths that either involve the heart directly or otherwise adversely affect the heart. Additionally, we aimed to warn physicians about these conditions, which nowadays have been diagnosed anywhere around the world due to growing migration, worldwide travel as well as the increasing number of immunosuppressed patients. In summary, our goal was to provide an overview on the heart diseases resulting from protozoal or helminth infection. Therefore, the discussion about the possible cardioprotective effects related to immunomodulation and/or alterations in human metabolism caused by parasitic infections is beyond the scope of our review.2

Indeed, the issue raised by Professors Abdoli and Rasti1 is very relevant. Since 2005, there is growing evidence that parasite infection—especially with geohelminths such as the roundworm and hookworm, insectborne helminths such as the filariae, and waterborne helminths such as the schistosomes—may provide some protection against atherogenesis and related cardiometabolic conditions, as demonstrated in different non-human animals and human studies summarised by Gurven et al.3 However, there is still no definite consensus on this protective effect and it has not been observed by some authors.4 5 Furthermore, the possible antiatherogenic mechanisms related to parasite infection remain uncertain. Thus, this is an important area of research, and further studies are needed to clarify the relationship between parasite infection and atherogenesis. These investigations may result into new therapeutic approach to prevent and/or treat atherosclerosis and associated cardiometabolic disorders.