[The relationship between Chlamydia pneumoniae and atherosclerosis]

Risk factors for arthrosclerosis have been well identified. More than ten years ago, an infectious process was incriminated, particularly the pathogenic effect of Chlamydia pneumoniae in the development of atheromatous lesions responsible for ischemic cardiovascular diseases.Several approaches have been used to assess the presence of a relationship between C. pneumoniae and the development of cardiovascular disease. Serological, histopathological (study of the atheromatous plaque), pathophysiological, and finally animal studies using models reproducing the human disease have generally favored an association. Therapeutic trials, especially those testing roxithromycin or azithromycin have demonstrated the action of secondary prevention of ischemic heart disease (unstable angina, myocardial infarction).The notion of an association between these two factors is biologically plausible. Several points remain to be clarified, particularly the need to develop a reliable diagnostic method for C. pneumoniae infections. It would also be useful to prove the viability of the pathogen within atheromatous plaques and finally to design studies of immune response to C. pneumoniae infections. Prospective therapeutic trials for primary prevention of cardiovascular disease would be most informative but would be most difficult to conduct.