Abstract
HYPOTHESIS: It is hypothesised that a combination of childhood and later life infections and excess food consumption, particularly of Western style food, initiates and contributes to atherosclerotic coronary heart disease. To consider this hypothesis we have conducted a brief review of the role of childhood infections, food, and their combined influence on atherosclerosis. EVIDENCE: (i) Studies of populations with high prevalence of infections and low "hunter gather" like food consumption, have extremely low prevalence of atherosclerosis, (ii) there are consistent associations between infections in childhood and adult atherosclerotic coronary heart disease, (iii) there is an association between increased body weight, (an indication of excess eating), and atherosclerotic heart disease, and (iv) there is evidence that a combination of increased body weight and infections influences the development of atherosclerotic coronary heart disease.Infections do not appear to act independently to cause atherosclerosis. A combination of both food and infection appears to be required to cause atheroma. CONCLUSION: The hypothesis that infections when combined with excess eating initiates atherosclerosis, is plausible. ACTION: Action aimed at prevention of atherosclerotic heart disease is possible. There are three safe approaches to prevention (i) encouragement of Mediterranean like diets, (ii) avoidance of overeating and (iii) vigorous control of infections among all age groups. There is a need to monitor patients with a history of serious childhood infections and poor nutrition. In addition, for high risk subjects, cholesterol lowering statins are of proven and safe value.