I’ve written right here earlier than about my rising conviction that coronary artery illness isn’t just about LDL, irritation, or dangerous luck. It’s time to discuss what is likely to be the elephant within the cath lab: an infection.
A latest pathology examine out of Japan checked out coronary plaque samples from sufferers with symptomatic CAD. Utilizing each immunohistochemistry and PCR, they discovered Chlamydia pneumoniae in each single pattern. All fifty plaques examined optimistic (100%), no matter whether or not the affected person had secure or unstable illness.
Take into consideration that.
This was not some serology correlation or “possibly it’s there” PCR noise. This was direct tissue affirmation in actual, dwelling sufferers. And once you pair that with a long time of mechanistic work displaying how this bug can set off oxidative stress, mitochondrial damage, and vascular easy muscle cell migration; it’s exhausting to maintain calling it an harmless bystander.
Sure, we’ve been down this street earlier than. We had the antibiotic trials. We had the headlines. And when they didn’t ship in superior illness, we packed all of it up and went again to statins and stents. However possibly we had been asking the improper query, within the improper sufferers, on the improper stage of illness.
We don’t throw out the tuberculosis speculation as a result of late-stage antibiotics can’t reverse cavitary lesions. We don’t dismiss HIV antivirals as a result of they don’t work in superior AIDS dementia. Timing issues. Focusing on issues.
This new pathology information ought to be our wake-up name. Allow us to resurrect the scientific trials, this time geared toward early illness, utilizing combos that hit totally different phases of the C. pneumoniae life cycle, and with non-invasive imaging endpoints that may truly detect a change earlier than it’s too late.
You probably have been studying my previous KevinMD posts, you recognize I’m not able to declare C. pneumoniae the only real reason behind CAD. However I’m saying the case is robust sufficient (and the stakes excessive sufficient) that abandoning the infectious speculation and not using a truthful trial is dangerous science and dangerous drugs.
It’s time to reopen the file.
To my colleagues designing cardiovascular trials (and to the NIH, NHLBI, and different funding companies), that is your second. The instruments are higher, the imaging is best, and the speculation is stronger than it has ever been. The subsequent “statin second” in cardiology may not be a lipid drug in any respect, however an antimicrobial technique. We won’t know until we’ve the braveness to check it, correctly, and shortly.
Larry Kaskel is an internist and “lipidologist in restoration” who has been practising drugs for greater than thirty-five years. He operates a concierge follow within the Chicago space and serves on the educating college on the Northwestern College Feinberg Faculty of Medication. As well as, he’s affiliated with Northwestern Lake Forest Hospital.
Earlier than podcasts entered mainstream tradition, Dr. Kaskel hosted Lipid Luminations on ReachMD, the place he produced a library of greater than 4 hundred applications that includes main voices in cardiology, lipidology, and preventive drugs.
He’s the creator of Dr. Kaskel’s Dwelling in Wellness, Quantity One: Let Meals Be Thy Medication, works that mix evidence-based medical follow with accessible methods for enhancing healthspan. His present tasks concentrate on reevaluating the ldl cholesterol speculation and investigating the infectious origins of atherosclerosis. Extra data is out there at larrykaskel.com.
