Background: There is an increasing body of evidence linking the human pathogen Chlamydia pneumoniae with atherosclerosis.
Methods: A Medline-based review of the literature was carried out.
Results and conclusion: Seroepidemiological studies have revealed the possibility that evidence of infection with C. pneumoniae and atherosclerotic disease are related. Studies on human tissue have demonstrated that evidence of the organism can be found in human atherosclerotic tissue by both direct and indirect methods significantly more often than in control vascular tissue. Using animal models it is possible to show that C. pneumoniae can be disseminated haematogenously following pulmonary infection and that it shows a tropism for atherosclerotic tissue. In vitro work has demonstrated that the organism is capable of infecting, surviving and multiplying in cells of the human vascular wall, and that it can provoke a cell-mediated cytokine response which has implications both locally and systemically. Two clinical trials of macrolide antibiotics have demonstrated that they confer increased cardiovascular protection in patients following myocardial infarction. Adequately powered trials are needed to establish the therapeutic role of antibiotics in peripheral arterial disease.