Microbial risk factors of cardiovascular and cerebrovascular diseases: potential therapeutical options

A Hidden Organism, Chlamydia in the Age of Atherosclerosis

Atherosclerosis is a chronic inflammatory disease. It is still the leading cause of mortality and morbidity in the world. Inflammation in the vessels plays the most important role in the pathogenesis of atherosclerosis. Many studies have been emphasized that Chlamydia pneumoniae triggers inflammation in the vessels and associated with atherosclerosis. It is stated that most of the chlamydial infections are asymptomatic and around 40% of adult individuals are infected. Chlamydia has different subgroups. It was thought to be a virus due to its intracellular pathogenicity, but it was included in the bacteria genus because it contains DNA and RNA chromosomes and has enzymatic activity. Chlamidya can easily be transmitted through the respiratory tract and sexual transmission. Seroepidemiological and pathological studies of atherosclerotic plaques showed the presence of Chlamydia in the plaque. This section will provide relationship between Chlamydia and atherosclerosis on the recent researces and current information will be discussed.

Effect of various doses of rosuvastatin in the treatment of elderly patients with unstable angina pectoris

OBJECTIVES

This prospective study aimed to explore the effects of various doses of rosuvastatin on the hemodynamic changes, highly sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) levels in elderly patients with unstable angina pectoris.

METHODS

One-hundred and six elderly patients with unstable angina pectoris were enrolled and divided into group A (n=55) and group B (n=51). Under the same treatment for angina pectoris, patients in groups A and B were administered with 5 mg and 10 mg of rosuvastatin orally once every night, respectively. The two groups were compared in terms of hemorheology, coagulation indices and immune reaction (serum hs-CRP and IL-6 levels), changes of clinical indices, electrocardiograph (ECG), therapeutic effect, and incidence of adverse reactions. Serum hs-CRP and IL-6 levels were detected by ELISA method, and their correlation was analyzed by Pearson method.

RESULTS

Whole blood viscosity at high cut (BVH), whole blood viscosity at low cut (BVL), plasma viscosity (PV), and erythrocyte sedimentation rate (ESR), immunoglobulin index, and the hs-CRP and IL-6 levels decreased in both groups after treatment and were lower in group B than in group A (P<0.05). Prothrombin time (PT) and activated partial thromboplastin time (APTT) increased, while fibrinogen (FIB) decreased in both groups after treatment (P<0.05). Group B was superior to group A in the onset times of myocardial ischemia and angina pectoris, the total duration of myocardial ischemia, and the total effective rate indicated by ECG (P<0.05). No statistical difference was observed in the incidence of adverse reactions between the two groups after treatment (P>0.05).

CONCLUSIONS

The optimal efficacy of rosuvastatin at 10 mg/day was higher than that of rosuvastatin at 5 mg/day.

Human cytomegalovirus-IgM seropositivity is not associated with atherogenic alterations of lipid profiles and inflammatory status in ischemic stroke patients: a preliminary study

BACKGROUND

Past exposure to human cytomegalovirus has been suggested to participate in the pathogenetic events associated with atherosclerotic lesion establishment and progression. However, whether ongoing human cytomegalovirus infection is related to plaque instability, and subsequent acute cerebral ischemia, is relatively unknown. The purpose of this study was to evaluate the potential relationships between active human cytomegalovirus infection and ischemic stroke, especially in regard to metabolism and inflammation.

METHODS

Ninety-nine acute ischemic stroke patients, associated with large artery atherosclerosis, were divided into two groups based on the presence or absence of human cytomegalovirus immunoglobulin M (IgM) (human cytomegalovirus-IgM-positive/human cytomegalovirus-IgM-negative = 33:66). Baseline clinical characteristics, inflammatory factors, and biochemical assessments were compared in both groups. Then, all patients and human cytomegalovirus-IgM-positive patients were divided into quartiles according to their high-sensitivity C-reactive protein levels, respectively, and risk factors were compared. Finally, correlations between inflammatory factors (high-sensitivity C-reactive protein and white blood cell count) and other atherosclerosis risk factors in both human cytomegalovirus-IgM-positive and -negative subjects were evaluated.

RESULTS

An association between human cytomegalovirus-IgM seropositivity and atherogenic modification of metabolism and inflammatory status were not found in this study. Both age and white blood cell count increased across quartiles of high-sensitivity C-reactive protein in all subjects (P = 0.001), while age and low-density lipoprotein cholesterol increased across quartiles of high-sensitivity C-reactive protein in the human cytomegalovirus-IgM-positive group (P = 0.02 and 0.007, respectively). Multivariate linear regression analysis showed that high-sensitivity C-reactive protein was associated with age in human cytomegalovirus-IgM-positive group (P = 0.002), while no other factor was associated with white blood cell count in these subjects.

CONCLUSION

Our study provided no evidence for the direct implication of active systemic human cytomegalovirus infection, represented by human cytomegalovirus-IgM positivity, in the pathogenesis of acute ischemic strokes, particularly those involving plaque instability and metabolic disorders.