Abstract
Besides traditional cardiovascular risk factors, e.g. hypertension, hyperlipoproteinemia, diabetes mellitus, obesity or smoking, there are new factors being discussed, such as infection and chronic inflammation, which may play a crucial role in the pathogenesis of atherosclerosis. The first conception of one single infectious agent, e.g Chlamydia pneumoniae, cytomegalovirus or Helicobacter pylori has been replaced by the theory of a synergistic effect of multiple pathogens; each of them may contribute to chronic low-grade inflammation.
Premature atherosclerosis manifestation has been further observed in patients with autoimmune diseases: systemic lupus erythematodes (SLE), rheumatoid arthritis (RA) or antiphospholipid syndrome (APS). Atherosclerosis is a chronic fibroproliferative disease initiated by endothelial damage, which is regulated by mechanisms of both innate and adaptive immunity.
Among inflammatory markers, ultrasensitive measurement of CRP is the most commonly used for cardiovascular risk assessment. Other parameters are used mostly in experiment.
Besides acetylsalicylic acid, certain anti-inflammatory properties have been attributed to other drugs commonly used in patients with advanced atherosclerosis: statins, ACE inhibitors, angiotensin receptor blockers. Experiments with biologic therapy are promising.