Polymorphism of the lipopolysaccharide receptor (CD14) and myocardial infarction. New evidence for a role of gram-negative bacterial infection?

Strong familial aggregation of coronary artery disease has long been recognized. Some of the increment of familial risk is attributable to established risk factors, such as plasma lipid levels, hypertension, smoking, and diabetes. Statistical regression studies, however, suggest that only 30% to 50% of the observed increment of coronary disease risk associated with a positive family history can be accounted for by canonical risk factors.1,2 Thus, significant factors remain to be discovered. These may involve retrieval of lipids from plaque, antioxidant defenses, endothelial dysfunction, abnormalities of platelet function, thrombogenesis and thrombolysis, and hereditary determinants of the inflammatory components of atherogenesis, among others.3