Dr Shor believes it is important for every medical practitioner to be aware of the new aspects of this disease, and that all facts concerning the circumstances, the finding of the germ, the specific pathological features and other aspects which change the concept of heart attacks, remarkably, methods of diagnoses of the lesion should all be known. Details and facets of the lesion are necessary for assessment, acceptance or rejection of this very important new disease, by the scientific community. It opens up new diagnosis and treatments, with potential cure and eradication of this deadly disease. Immunization or eradication of this germ if possible will open new horizons. TOC:Introduction.- The Germ's Story.- The Deadly Disease.- Atheroma Gruel.- Discovery.- Which Chlamydia Species.- Identification of Atheroma Germ.- Publications, Presentations and Confirmation.- Chlamydia are Inherent Components of Atheroma.- Do Chlamydia Germs Cause Atherosclerosis?- Pathological Lesion Diagnosis.- Study of Atheroma Lesions.- New Findings Concerning Initial Lesion.- Fatty Streak Lesion.- Formation of Fibro-Necrotic Plaque.- Interpretaton of Lesion.- Confirmatory Molecular Biological Studies.- Derivation of Lipid in Lesion.- Acceptance.- Diagnosis of Atheroma Lesions.- Treatment.- Pathological Study.- Other Studies.- What Do We Know About Treatment of Atheroma Lesions.- Other Treatment Possibilities.- Conclusion. Dr Shor believes it is important for every medical practitioner to be aware of the new aspects of this disease, and that all facts concerning the circumstances, the finding of the germ, the specific pathological features and other aspects which change the concept of heart attacks, remarkably, methods of diagnoses of the lesion should all be known. Details and facets of the lesion are necessary for assessment, acceptance or rejection of this very important new disease, by the scientific community. It opens up new diagnosis and treatments, with potential cure and eradication of this deadly disease. Immunization or eradication of this germ if possible will open new horizons. Preface vii Chapter 1 Introduction 1 1.1 Killer Germs That Clog Arteries 1 Chapter 2 The Germ's Story 3 2.1 A Life of Infection and Destruction 3 Chapter 3 The Deadly Disease 6 3.1 A Very Common Disease 6 3.2 A Little Bit of History 8 3.3 Research 10 3.4 Cholesterol 10 3.5 Other Components 11 3.6 Molecular Biology of the Lesion 12 3.7 The Age of Statistics 12 3.8 Animal Studies 13 3.9 Modern View of the Lesion 13 Chapter 4 Atheroma Gruel 17 4.1 Study of Fatty Gruel That Clogs Arteries 17 4.2 Electron Microscope 19 4.3 Electron Microscopic Features of Atheroma Gruel 20 Chapter 5 Discovery 29 5.1 Does Atheroma Gruel Consist of Fat or Germs? 29 5.2 Which Germ? 30 5.3 A Chlamydia Germ 31 Chapter 6 Which Chlamydia Species? 35 6.1 Some Unique Features of the Chlamydia Germ in Atheroma 35 6.2 Not Conventional Chlamydia Species 36 6.3 A New Chlamydia Species 37 6.4 Other Chlamydia Species 41 Chapter 7 Identification of the Atheroma Germ 43 7.1 Attempts at Identification of the Germ 43 7.2 Positive Identification of Chlamydia TWAR 45 7.3 Methods of Identification 45 Chapter 8 Publications, Presentations, and Confirmation 48 8.1 Publications 48 8.2 Presentations 49 8.3 Confirmation 50 8.4 Possible Special Strain of Chlamydia pneumoniae 50 Chapter 9 Chlamydia Are Inherent Components of Atheroma 54 9.1 Serology Not Helpful 54 9.2 Previous Journal Articles on Atheroma Contain Pictures of Unrecognized Chlamydia Germs 55 9.3 Persons with Congenital Raised Cholesterol Contain Chlamydia pneumoniae Germs in Atheroma 56 9.4 Are There Other Germs in Atheroma? 57 Chapter 10 Do Chlamydia Germs Cause Atherosclerosis? 60 10.1 Determining Causality 60 10.2 Statistical Criteria 61 10.3 Koch's Postulates 62 10.4 Does Eradication of Germ Prove Causality? 62 10.5 No Disease Without Causal Agent 63 Chapter 11 Pathological Lesion Diagnosis 64 11.1 Lesion Examination 64 11.2 Lesion Diagnosis 65 11.3 Inability to Diagnose Atheroma Lesion 65 Chapter 12 Study of Atheroma Lesions 67 12.1 Steps in Atheroma Lesion Formation 67 12.2 Aspects Requiring Reexamination 68 12.3 Addressing the Problem of Atheroma Lesion Formation 68 Chapter 13 New Findings Concerning the Initial Lesion 71 13.1 Initial Lesion 71 13.2 Primary Muscle Damage 72 13.3 Chlamydia Cause Muscle Cell Damage 80 Chapter 14 Fatty Streak Lesion 82 14.1 Macrophage Infiltration 82 14.2 Macrophages Phagocytose Fat, Germs, and Muscle 82 14.3 Macrophage Reaction Resulting from Germs and Muscle Damage 87 Chapter 15 Formation of Fibronecrotic Plaque 89 15.1 Formation of Atheroma Gruel 89 15.2 Ceroid or Blighted Chlamydia Vacuoles? 95 15.3 Cholesterol Crystallization 98 15.4 Late Sequelae: Fibrosis, Calcification, and Angiogenesis 101 Chapter 16 Interpretation of Lesion 104 16.1 Another Way to Look at the Lesion 104 16.2 Assessment of Evidence 109 16.3 What Do We Call the Lesion? 111 Chapter 17 Confirmatory Molecular Biological Studies 112 17.1 Is Lymphocytic Infiltrate Caused by Chlamydia? 112 17.2 Intimal Smooth Muscle Cell Damage 113 17.3 Monocyte and Macrophage Infiltrate 113 17.4 Endothelial Changes 114 17.5 Collagen Formation 114 Chapter 18 Derivation of Lipid in Lesion 117 18.1 Atheroma Lipid 117 18.2 Chlamydia Lipid 119 18.3 Cholesterol: Friend or Foe? 121 Chapter 19 Acceptance 124 19.1 Old Ideas Do Not Change 124 19.2 Rejection of New Ideas 125 Chapter 20 Diagnosis of Atheroma Lesions 127 20.1 Serology 128 20.2 Heat Shock Protein 128 20.3 C-Reactive Protein 128 20.4 Detection of Chlamydia in White Blood Cells and Blood 129 20.5 Other Possible Tests 129 20.6 Pathological Diagnosis 129 20.7 Chlamydia Inclusion Bodies 129 20.8 Electron Microscopy 130 20.9 Immunohistochemical Detection 130 20.10 Polymerase Chain Reaction 130 20.11 Culture 130 Chapter 21 Treatment 132 21.1 Antibiotic Sensitivity 133 21.2 What Happens to the Lesion? 134 21.3 Does the Lesion Change in Size? 134 21.4 Does the Lesion Change in Character? 135 Chapter 22 Pathological Study 137 22.1 Eradication of Germ 138 22.2 Size of Lesion 139 22.3 Stage of Lesion 139 22.4 Decrease in Inflammation 139 22.5 Fibrosis and Scar Formation 139 22.6 Regeneration 142 22.7 Does Treatment Increase Healing? 142 Chapter 23 Other Studies 144 23.1 Animal Studies 144 23.2 Retrospective Studies 144 23.3 Secondary Prevention Trials 145 23.4 Meta-Analysis 147 23.5 Relevance of Clinical Trials 147 23.6 Unconsidered Aspects 147 23.7 Noncardiac Treatment Trials 148 Chapter 24 What Do We Know About Treatment of Atheroma Lesions? 151 24.1 Physiology of the Heart 151 24.2 What Causes a Heart Attack? ?152 24.3 Atherosclerosis Is Not the Same as Ischemic Heart Disease 153 Chapter 25 Other Treatment Possibilities 155 25.1 Statins 155 25.2 Aspirin 156 25.3 Antihypertensive Agents 157 25.4 New Innovative Agents 157 25.5 Immunization 158 Chapter 26 Conclusion 160 Glossary of Terms 161 Index 163