Editorials

Inflammatory responses and coronary heart disease

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7136.953 (Published 28 March 1998) Cite this as: BMJ 1998;316:953

The “dirty chicken” hypothesis of cardiovascular risk factors

  1. Michael A Mendall, Consultant gastroenterologist and senior lecturer
  1. Mayday Hospital, Thornton Heath, Surrey CR7 7YE

    The “dirty chicken” hypothesis was proposed by Solomons to explain why children reared in poverty, though appearing healthy and receiving adequate nutrition, end up as short adults.1 Based on the observation that antibiotic supplementation reverses poor growth in chickens reared in overcrowded unhygienic conditions, he suggested that chronic subclinical infection induces a low grade systemic inflammation and that this produces a qualitatively similar effect to full blown acute inflammation—that is, chronic anorexia and increased basal metabolic rate, with cytokines being the mediators. What does this have to do with humans reared in relatively overcrowded unhygienic conditions and cardiovascular disease?

    There is an increasing interest in the relation between chronic low grade systemic inflammation, as indicated by serum levels of C reactive protein, and mortality from coronary heart disease. 2 3 There has, however, been little knowledge of the determinants of this response and its importance in the pathogenesis of atherosclerosis. Chronic subclinical infection with Chlamydia pneumoniae, Helicobacter pylori, chronic bronchitis, and chronic dental sepsis have been associated with raised values of C reactive protein within the normal range3 and have been implicated …

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