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To the Editor:The figure that appears in the article by Libby et al,1 as well as on the cover of the same edition, shows atherosclerosis as a lipid infiltrative type of lesion with primary attachment and infiltration of monocyte/macrophage foam cells.1 Pathological studies, however, show additional features, such as the foam cell component consisting of a combination of macrophages and intimal smooth muscle cells, and containing not only lipid but Chlamydia pneumoniae (Cp) organisms as well. Another feature is fragmentation and necrosis of Cp- infected intimal smooth muscle cells, with a monocyte/macrophage response showing engulfment not only of lipid, but also of muscle fragments and Cp organisms.2 When examined with an electron microscope, the central lipid-rich core consists mainly of a colony of lipophilic Cp organisms, not lipids as previously thought.2This type of arterial lesion seems to occur even in patients with cholesterol disorders. The association of the hypercholesterolemia and premature severe atherosclerosis in homozygous familial …

Atherosclerosis: Lipid Infiltration or Chlamydia pneumoniae Infection?