Heart attacks may be triggered by bacteria

DaveZale | 65 points

This is a nicely-designed study. For decades, we've known that inflammation is a risk factor for heart attacks.

In this study, the researchers designed a custom antibody that binds to oral bacteria. Then they used histological staining to identify specific biofilm structures inside the atherosclerotic tissue. Bacteria released from the biofilm were observed in heart attack cases, which gives us evidence that when the body's immune system responded to these bacteria, it triggered inflammation which ruptured cholesterol-laden plaque. So now we have more insight into the mechanism behind why inflammation is associated with heart attack risk.

The "pantheon" of risk factors for heart disease are:

* hs-CRP (inflammation): the mechanism studied by this research. High inflammation roughly doubles your risk of heart disease.

* ApoB - 20% of people with normal cholesterol will have abnormal ApoB, and be at risk of heart disease (ApoB is a structural protein in lipoproteins which cause arterial plaque).

* Lp(a) - the strongest hereditary risk factor for heart disease (Lp(a) acts as a multiplier on ApoB, since it camouflages cholesterol particles from your liver)

* HbA1c - insulin resistance /diabetes is a risk factor for just about everything.

* eGFR - estimates the volume of liquid your kidneys can filter, and is an input to the latest heart disease risk models (PREVENT).

All of these risk factors can be measured with a blood test. Easy to order online: https://www.empirical.health/product/comprehensive-health-pa...

brandonb | 33 minutes ago

This raises two questions.

- Does this suggest that courses of antibiotics might reduce heart attack risk?

- Does this suggest that regular use of, e.g., Listerine might reduce heart attack risk? (While, perhaps, slightly increasing esophageal cancer risk.)

It would be interesting to run an epidemiological study to see if current interventions move the needle in a meaningful way.

A_D_E_P_T | 4 minutes ago

I assume this is a "here's another way this can happen" rather than "actually this is caused only by this and not by what we used to think"?

tbrownaw | an hour ago

“Dormant bacteria within the biofilm remain[ing] shielded from both the patient’s immune system and antibiotics because they cannot penetrate the biofilm matrix…”

Phages can penetrate biofilms [1]. (They have practice.)

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8875263/

JumpCrisscross | 22 minutes ago

The original title is "Myocardial infarction may be an infectious disease" which appears to be clickbait, with the title posted here being much more accurate.

Immune response to bacteria in arterial plaques can cause them to break up and cause the attack (my lay-interpretation) so the bacteria is a trigger, but "infectious disease" is a bit of hyperbole.

andy99 | an hour ago

This seems like a good explanation of how my father died. He had the flu, and died overnight from a massive heart attack.

op00to | 42 minutes ago