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Kardiologie up2date 2006; 2(3): 275-283
DOI: 10.1055/s-2006-944816
Koronare Herzerkrankung und Arteriosklerose
© Georg Thieme Verlag Stuttgart · New York

Infektion und Arteriosklerose

Dorit  Knappe, Jan  Kähler
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Publication History

Publication Date:
05 October 2006 (online)

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Kernaussagen

Chronische Infektionen mit Zytomegalievirus, Herpes-simplex-Virus-1 und 2, Chlamydia pneumoniae, Helicobacter pylori, Hepatitis-A-Virus, periodontalen Erregern und Enteroviren sind mit einer erhöhten Prävalenz von arteriosklerotischen Erkrankungen assoziiert.

Die Aussagekraft der seroepidemiologischen Studien ist limitiert. Verantwortlich dafür sind eine hohe Prävalenz der Erreger, eine variable Antikörperantwort und der Umstand, dass es sich meist um Querschnittsstudien handelt.

Lipopolysaccharide stimulieren die Zytokinsynthese und interagieren mit dem Lipidmetabolismus. Mikrobielle Hitzeschockproteine werden aufgrund ihrer ähnlichen Sequenz zum humanen Protein als Trigger eines Autoimmunprozesses angesehen.

Zwischen Infektionen und den etablierten Risikofaktoren bestehen zahlreiche Interaktionen: Rauchen prädisponiert für eine chronische C.-pneumoniae-Infektion. Chronische Entzündungen führen zu einer Veränderung des Lipidmetabolismus in Richtung eines atherogenen Lipidprofils.

Über 20 randomisierte Antibiotikastudien zur Sekundärprophylaxe der KHK mit fast 20 000 Patienten wurden bisher publiziert. Untersucht wurden die Effekte auf die Endothelfunktion, Mortalität und erneute kardiovaskuläre Ereignisse sowie die Wirkung auf inflammatorische Marker. Ein klinischer Nutzen der Therapie konnte bisher nicht nachgewiesen werden.

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PD Dr. med. Jan Kähler

Klinik und Poliklinik für Kardiologie/Angiologie

Universitäres Herzzentrum Hamburg · Martinistraße 52 · 20246 Hamburg

Email: kaehler@uke.uni-hamburg.de