A perspective on Chlamydia pneumoniae and coronary heart disease

Part of the Developments in Cardiovascular Medicine book series (DICM, volume 218)


There is a consistent association between evidence of the presence of Chlamydia pneumoniae infection and coronary heart disease (CHD), but a causal relationship between the organism and atherogenesis has not been established (See Table 11). Since the original report in 1988 suggesting that C. pneumoniae was linked with CHD, there has been, understandably, a rather mixed response from the scientific community, including doubt, speculation, excitement and intense research. The original observations have led to numerous follow-up investigations in many countries. These included: seroepidemiological studies showing associations between anti-C. pneumoniae antibodies and CHD, positive identification of the organism within, and its culture from, atheroma; development of animal models of C. pneumoniae-induced atherogenesis; in vitro studies providing evidence of an ‘infectious’ basis for atherogenesis; and clinical intervention secondary prevention studies using antichlamydial antibiotics. The international nature of research in this field can be seen from the map in Figure 12, which highlights countries where important studies have been carried out or are ongoing.


Coronary Heart Disease Chronic Infection Define Daily Dose Coronary Heart Disease Patient Seroepidemiological Study 


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  1. 1.
    Gupta S. Chlamydia pneumoniae, monocyte activation and antimicrobial therapy in coronary heart disease. MD Thesis, 1999 (University of London, UK).Google Scholar
  2. 2.
    Saikku P, Mattila KJ, Nieminen MS et al. Serological evidence of an association of a novel chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction. Lancet 1988; ii: 983–6.CrossRefGoogle Scholar
  3. 3.
    Danesh J, Collins R, Peto R. Chronic infections and coronary heart disease: Is there a link? Lancet 1997; 350: 430–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Gibbs RG and Davies AH. Chlamydia pneumoniae and vascular disease. Br J Surg 1998; 85: 1191–7.PubMedCrossRefGoogle Scholar
  5. 5.
    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: 979–82.PubMedGoogle Scholar
  6. 6.
    Jackson LA, Campbell LA, Kuo CC et al. Isolation of Chlamydia pneumoniae from a carotid endarterectomy specimen. J Infect Dis 1997; 176: 292–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Maass M, Bartels C, Engel PM, Mamut U, Sievens HH. Endovascular presence of viable Chlamydia pneumoniae is a common phenomenon in coronary artery disease. J Am Coll Cardiol 1998; 31: 827–32.PubMedCrossRefGoogle Scholar
  8. 8.
    Fong IW, Chiu B, Viira E et al. Rabbit models for Chlamydia pneumoniae infection. J Clin Microbiol 1997; 35: 48–52.PubMedGoogle Scholar
  9. 9.
    Laitinen K, Laurila A, Pyhälä L, Leinonen M, Saikku P. Chlamydia pneumoniae infection induces inflammatory changes in the aortas of rabbits. Infect Immun 1997; 65: 4832–5.PubMedGoogle Scholar
  10. 10.
    Muhlestein JB, Anderson JL, Hammond EH et al. Infection with Chlamydia pneumoniae accelerates the development of atherosclerosis and treatment with azithromycin prevents it in a rabbit model. Circulation 1998; 97: 633–6.PubMedGoogle Scholar
  11. 11.
    Gupta S, Leatham EW, Carrington D et al. Elevated Chlamydia pneumoniae antibodies, cardiovascular events and azithromycin in male survivors of myocardial infarction. Circulation 1997; 96: 404–17.PubMedGoogle Scholar
  12. 12.
    Gurfinkel E, Bozovich G, Darcoca A, Beck E, Mantner B. Randomised trial of roxithromycin in non-Q-wave coronary syndromes: ROXIS pilot study. Lancet 1997; 350: 404–17.PubMedCrossRefGoogle Scholar
  13. 13.
    Hart CA. Antibiotic resistance: an increasing problem? BMJ 1998; 316: 1255–6.PubMedGoogle Scholar
  14. 14.
    Ånestad G, Scheel G, Hugnes O. Chronic infections and coronary heart disease. Lancet 1997, 350: 1028 [letter].PubMedCrossRefGoogle Scholar

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© Kluwer Academic Publishers 1999

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