TY - JOUR
AU1 - Pothineni, Naga Venkata Krishna Chand
AU2 - Mehta, Jawahar L
AB - This commentary refers to ‘Are intestinal worms nature’s anti-atherosclerosis vaccine?’, by M.D. Gurven et al., on page 1653. We thank Gurven et al.1 for their insightful commentary on the role of helminths in the pathogenesis and epidemiology of atherosclerotic cardiovascular disease. They highlight the symbiotic relationship of intestinal helminths with humans, and associate high burden of these parasites to low incidence of coronary calcification in specific populations, the Tismanes in the Amazon basin. Although the supportive data is highly suggestive, we believe these observations are mere associations and do not reflect a cause and effect. As the authors recognize, there are conflicting reports on the relationship of co-infection on cardiovascular outcomes. Generally, subjects that have parasitic infections have poor oral hygiene, higher periodontal/gingival infections, and high incidence of viral infections which have been associated with progressive atherosclerosis. Although the Th2 response seen in parasitic infections may be anti-inflammatory, we believe there are multiple confounding factors to suggest an inverse association with atherosclerosis. In the cross-sectional study on the Tisimane population, obesity, hypertension, high blood sugar, and regular cigarette smoking were rare. That may well be an important link leading to lower prevalence of atherosclerotic coronary disease in these populations. Dietary patterns (high fibre and low-saturated fat) may also play a significant role. In addition, the Tsimane population have been reported to have a very active lifestyle with <10% of day light hours being sedentary.2 An interesting finding however is the relatively high levels of inflammatory markers in this population that did not correlate with the degree of coronary atherosclerosis. Relationship of inflammatory biomarkers and atherogenesis is convincing.3 In summary, we believe that the existing evidence supporting a pro- or anti-atherosclerotic effect of various infections, including helminthic infections is, limited due to the lack of data to establish a cause-effect relationship. To the best of our knowledge, as we presented in our review, no anti-infective therapy has been consistently shown to reduce cardiovascular disease burden, except for Influenza vaccination showing reduced rates of acute coronary syndrome events.4 Various confounding factors such as diet, lifestyle and genetic factors have a much stronger impact on the pathogenesis and outcomes of atherosclerotic heart disease, and identifying a role of a specific infection above and beyond these traditional risk factors may be challenging. Conflict of interest: none declared. References 1 Gurven MD , Finch CE, Wann LS. Are intestinal worms nature’s anti-atherosclerosis vaccine? Eur Heart J 2018 ; 39 : 1653 . Google Scholar OpenURL Placeholder Text WorldCat 2 Kaplan H , Thompson RC, Trumble BC, Wann LS, Allam AH, Beheim B, Frohlich B, Sutherland ML, Sutherland JD, Stieglitz J, Rodriguez DE, Michalik DE, Rowan CJ, Lombardi GP, Bedi R, Garcia AR, Min JK, Narula J, Finch CE, Gurven M, Thomas GS. Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study . Lancet 2017 ; 389 : 1730 – 1739 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Pant S , Deshmukh A, Gurumurthy GS, Pothineni NV, Watts TE, Romeo F, Mehta JL. Inflammation and atherosclerosis–revisited . J Cardiovasc Pharmacol Ther 2014 ; 19 : 170 – 178 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Pothineni NVK , Subramany S, Kuriakose K, Shirazi LF, Romeo F, Shah PK, Mehta JL. Infections, atherosclerosis, and coronary heart disease . Eur Heart J 2017 ; 38 : 3195 – 3201 . Google Scholar Crossref Search ADS PubMed WorldCat Published by Oxford University Press on behalf of the European Society of Cardiology 2018. This work is written by US Government employees and is in the public domain in the US. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) Published by Oxford University Press on behalf of the European Society of Cardiology 2018. This work is written by US Government employees and is in the public domain in the US.
TI - Can certain infections protect against atherosclerosis?
JF - European Heart Journal
DO - 10.1093/eurheartj/ehy130
DA - 2018-04-11
UR - https://www.deepdyve.com/lp/oxford-university-press/can-certain-infections-protect-against-atherosclerosis-buahtheLff
SP - 1654
EP - 1654
VL - 39
IS - 18
DP - DeepDyve
ER -