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Can certain infections protect against atherosclerosis?

Can certain infections protect against atherosclerosis? DISCUSSION FORUM European Heart Journal (2018) 39, 1654 doi:10.1093/eurheartj/ehy130 Can certain infections protect against atherosclerosis? Naga Venkata Krishna Chand Pothineni and Jawahar L. Mehta* Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA Online publish-ahead-of-print 11 April 2018 This commentary refers to ‘Are intestinal worms nature’s that did not correlate with the degree of coronary atherosclerosis. anti-atherosclerosis vaccine?’, by M.D. Gurven et al., on . Relationship of inflammatory biomarkers and atherogenesis is page 1653. . convincing. In summary, we believe that the existing evidence supporting a pro- 1 . We thank Gurven et al. for their insightful commentary on the role . or anti-atherosclerotic effect of various infections, including helminthic of helminths in the pathogenesis and epidemiology of atherosclerotic . infections is, limited due to the lack of data to establish a cause-effect cardiovascular disease. They highlight the symbiotic relationship of in- relationship. To the best of our knowledge, as we presented in our re- testinal helminths with humans, and associate high burden of these . view, no anti-infective therapy has been consistently shown to reduce parasites to low incidence of coronary calcification in specific popula- . cardiovascular disease burden, except for Influenza vaccination show- . 4 tions, the Tismanes in the Amazon basin. Although the supportive . ing reduced rates of acute coronary syndrome events. Various con- data is highly suggestive, we believe these observations are mere as- founding factors such as diet, lifestyle and genetic factors have a much sociations and do not reflect a cause and effect. As the authors recog- stronger impact on the pathogenesis and outcomes of atherosclerotic nize, there are conflicting reports on the relationship of co-infection heart disease, and identifying a role of a specific infection above and on cardiovascular outcomes. Generally, subjects that have parasitic beyond these traditional risk factors may be challenging. infections have poor oral hygiene, higher periodontal/gingival infec- Conflict of interest: none declared. tions, and high incidence of viral infections which have been associ- ated with progressive atherosclerosis. Although the Th2 response References seen in parasitic infections may be anti-inflammatory, we believe . 1. Gurven MD, Finch CE, Wann LS. Are intestinal worms nature’s anti-atherosclero- there are multiple confounding factors to suggest an inverse associ- sis vaccine? Eur Heart J 2018;39:1653. ation with atherosclerosis. In the cross-sectional study on the 2. Kaplan H, Thompson RC, Trumble BC, Wann LS, Allam AH, Beheim B, Frohlich Tisimane population, obesity, hypertension, high blood sugar, and . 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 regular cigarette smoking were rare. That may well be an important GS. Coronary atherosclerosis in indigenous South American Tsimane: a cross- link leading to lower prevalence of atherosclerotic coronary disease sectional cohort study. Lancet 2017;389:1730–1739. in these populations. Dietary patterns (high fibre and low-saturated . 3. Pant S, Deshmukh A, Gurumurthy GS, Pothineni NV, Watts TE, Romeo F, Mehta JL. Inflammation and atherosclerosis–revisited. J Cardiovasc Pharmacol Ther 2014; fat) may also play a significant role. In addition, the Tsimane popula- . 19:170–178. tion have been reported to have a very active lifestyle with <10% of . 4. Pothineni NVK, Subramany S, Kuriakose K, Shirazi LF, Romeo F, Shah PK, Mehta 2 . day light hours being sedentary. An interesting finding however is . JL. Infections, atherosclerosis, and coronary heart disease. Eur Heart J 2017;38: the relatively high levels of inflammatory markers in this population . 3195–3201. * Corresponding author. Tel: 501-296-1401, Fax: 501-686-6001, Email: mehtajl@uams.edu 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Can certain infections protect against atherosclerosis?

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Publisher
Oxford University Press
Copyright
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.
ISSN
0195-668X
eISSN
1522-9645
DOI
10.1093/eurheartj/ehy130
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Abstract

DISCUSSION FORUM European Heart Journal (2018) 39, 1654 doi:10.1093/eurheartj/ehy130 Can certain infections protect against atherosclerosis? Naga Venkata Krishna Chand Pothineni and Jawahar L. Mehta* Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA Online publish-ahead-of-print 11 April 2018 This commentary refers to ‘Are intestinal worms nature’s that did not correlate with the degree of coronary atherosclerosis. anti-atherosclerosis vaccine?’, by M.D. Gurven et al., on . Relationship of inflammatory biomarkers and atherogenesis is page 1653. . convincing. In summary, we believe that the existing evidence supporting a pro- 1 . We thank Gurven et al. for their insightful commentary on the role . or anti-atherosclerotic effect of various infections, including helminthic of helminths in the pathogenesis and epidemiology of atherosclerotic . infections is, limited due to the lack of data to establish a cause-effect cardiovascular disease. They highlight the symbiotic relationship of in- relationship. To the best of our knowledge, as we presented in our re- testinal helminths with humans, and associate high burden of these . view, no anti-infective therapy has been consistently shown to reduce parasites to low incidence of coronary calcification in specific popula- . cardiovascular disease burden, except for Influenza vaccination show- . 4 tions, the Tismanes in the Amazon basin. Although the supportive . ing reduced rates of acute coronary syndrome events. Various con- data is highly suggestive, we believe these observations are mere as- founding factors such as diet, lifestyle and genetic factors have a much sociations and do not reflect a cause and effect. As the authors recog- stronger impact on the pathogenesis and outcomes of atherosclerotic nize, there are conflicting reports on the relationship of co-infection heart disease, and identifying a role of a specific infection above and on cardiovascular outcomes. Generally, subjects that have parasitic beyond these traditional risk factors may be challenging. infections have poor oral hygiene, higher periodontal/gingival infec- Conflict of interest: none declared. tions, and high incidence of viral infections which have been associ- ated with progressive atherosclerosis. Although the Th2 response References seen in parasitic infections may be anti-inflammatory, we believe . 1. Gurven MD, Finch CE, Wann LS. Are intestinal worms nature’s anti-atherosclero- there are multiple confounding factors to suggest an inverse associ- sis vaccine? Eur Heart J 2018;39:1653. ation with atherosclerosis. In the cross-sectional study on the 2. Kaplan H, Thompson RC, Trumble BC, Wann LS, Allam AH, Beheim B, Frohlich Tisimane population, obesity, hypertension, high blood sugar, and . 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 regular cigarette smoking were rare. That may well be an important GS. Coronary atherosclerosis in indigenous South American Tsimane: a cross- link leading to lower prevalence of atherosclerotic coronary disease sectional cohort study. Lancet 2017;389:1730–1739. in these populations. Dietary patterns (high fibre and low-saturated . 3. Pant S, Deshmukh A, Gurumurthy GS, Pothineni NV, Watts TE, Romeo F, Mehta JL. Inflammation and atherosclerosis–revisited. J Cardiovasc Pharmacol Ther 2014; fat) may also play a significant role. In addition, the Tsimane popula- . 19:170–178. tion have been reported to have a very active lifestyle with <10% of . 4. Pothineni NVK, Subramany S, Kuriakose K, Shirazi LF, Romeo F, Shah PK, Mehta 2 . day light hours being sedentary. An interesting finding however is . JL. Infections, atherosclerosis, and coronary heart disease. Eur Heart J 2017;38: the relatively high levels of inflammatory markers in this population . 3195–3201. * Corresponding author. Tel: 501-296-1401, Fax: 501-686-6001, Email: mehtajl@uams.edu 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.

Journal

European Heart Journal – Oxford University Press

Published: Apr 11, 2018

Keywords: atherosclerosis; infections

References

  • Are intestinal worms nature’s anti-atherosclerosis vaccine?
    Gurven, MD; Finch, CE; Wann, LS
  • Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study
    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.
  • Inflammation and atherosclerosis–revisited
    Pant, S; Deshmukh, A; Gurumurthy, GS; Pothineni, NV; Watts, TE; Romeo, F; Mehta, JL.
  • Infections, atherosclerosis, and coronary heart disease
    Pothineni, NVK; Subramany, S; Kuriakose, K; Shirazi, LF; Romeo, F; Shah, PK; Mehta, JL.