Carotid atherosclerosis is not related to past tuberculosis in hypercholesterolemic patients
Introduction
Conventional cardiovascular risk factors [1], [2] fail to completely explain the observed variations in the prevalence and severity of clinical atherosclerotic disease. Many studies support the concept that immune and inflammatory responses play an important role in atherosclerosis [3], [4] and chronic infections may have an etiological role in the development of atherosclerosis and CHD, either independently or by interacting with traditional atherogenic risk factors [5], [6]. A large number of studies have reported on the association of cardiovascular diseases and certain persistent bacterial and viral infections, including Chlamydia pneumoniae, herpes virus and CMV [7], [8], [9], [10]. Furthermore, carotid atherosclerosis, which is a surrogate marker of cardiovascular disease [1], [11], is increased in patients with chronic infection [12].
Tuberculosis is a chronic recurrent infection [13], [14], [15] and inflammation is part of the disease which may remain undiagnosed for months [1], [16]. Thus tuberculosis could be involved at two levels in the atherogenic process: first because of chronic inflammation [14], [17] and secondly because studies in animal models have shown that immunization with recombinant heat shock protein-65-rich mycobacterium tuberculosis increased atherogenesis, with enhanced fatty streak formation in rodents fed a high cholesterol diet [18], [19]. Until now, no clinical relationship between myocardial infarction and tuberculosis has been already described, even if there is a similar pathophysiology between plaque evolution and tuberculosis [20]. Furthermore, there is no recent specific study linking atherosclerotic lesion development and tuberculosis in man. The aim of our study was therefore to investigate the potential interrelationships between past tuberculosis with carotid and femoral atherosclerosis assessed by echography in hypercholesterolemic patients.
Section snippets
Patients
This case control study involved two groups of patients referred to our cardiovascular prevention center for dyslipidemia by their general practitioner because they had either hypercholesterolemia (LDL-cholesterol > 160 mg/dL), hypertriglyceridemia (triglycerides > 150 mg/dL) or low HDL-cholesterol levels (<35 mg/dL).
The first group was constituted of patients whose medical history revealed past tuberculosis. Each of these patients was age (±1 year) and sex-matched with a patient seen in our center
Results
A total of 147 hypercholesterolemic patients with clinical tuberculosis were compared to 147 matched, hypercholesterolemic controls. The meantime between tuberculosis and the sonography was 25 ± 11 years and 50% of the patients had tuberculosis before 30-year-old. Sixty-nine percent of patients with past tuberculosis had pulmonary tuberculosis. None of the patients were HIV infected.
The biological and clinical characteristics of patients and controls are listed in Table 1. None of the variables
Discussion
Tuberculosis is a chronic fibrotic disease with inflammation and immune modification. Particularly in Caucasians, the disease may remain undiagnosed for months [14], [16]. The linkage of tuberculosis to atherosclerosis is an old concept based on the one hand on the coexistence of arteriosclerosis and tuberculosis at autopsy in old studies and on the other hand with coincident epidemiological data linking the introduction of antibiotic therapy to the decline of cardiovascular disease and
References (45)
- et al.
Chlamydia pneumoniae IgG titres and coronary heart disease: prospective study and meta-analysis
BMJ
(2000) - et al.
Differential association of common carotid intima–media thickness and carotid atherosclerotic plaques with parental history of premature death from coronary heart disease: the EVA Study
Arterioscler Thromb Vasc Biol
(1999) - et al.
Serum matrix metalloproteinase-3 and tissue inhibitor of metalloproteinases-1 as potential markers of carotid atherosclerosis in infraclinical hyperlipidemia
Atherosclerosis
(2003) - et al.
Elevated C-reactive protein constitutes an independent predictor of advanced carotid plaques in dyslipidemic subjects
Arterioscler Thromb Vasc Biol
(2001) - et al.
Atherosclerosis and tuberculosis: are they both chronic infectious diseases?
Scand J Infect Dis
(2001) Plague (tuberculosis) and plaque (atherosclerosis)
N Engl J Med
(1977)- et al.
Association of serum antibodies to heat-shock protein 65 with carotid atherosclerosis—clinical significance determined in a follow up study
Circulation
(1999) - et al.
Clinical value of the measurement of Mycobacterium tuberculosis specific antibody in pulmonary tuberculosis
Thorax
(1992) - et al.
Pravastatin or atorvastatin evaluation and infection therapy-thrombolysis in myocardial infarction 22 investigators. Antibiotic treatment of Chlamydia pneumoniae after acute coronary syndrome
N Engl J Med
(2005) Novel risk markers and clinical practice
N Engl J Med
(2003)