Viral infection and atherosclerosis: A systematic review and meta-analysis

Aims: Viruses are frequently mentioned as infectious agents with a link to atherosclerosis, although their significance in the initiation and progression of atherosclerosis remains under-reported. These viruses infect vascular cells, causing endothelium and smooth muscle inflammation, or non-vascular cells, causing systemic inflammation. This systematic review aimed to identify and evaluate the most prevalent viral pathogen associated with the development and progression of atherosclerosis. Methodology and results: PubMed, Web of Science, iCITE, Google Scholar, Science Direct and Scopus databases were searched for relevant studies. Using quality and bias risk evaluation, we narrowed the number of evaluated publications to 55. Two data collectors independently gathered the data, and a third party was brought in for consultation in case of any discrepancies. This study involving 117,493 individuals from case-control, cohort, and cross-sectional studies suggests that viral infections could elevate the susceptibility to atherosclerosis. This study found an association between HCMV, HSV, VZV and atherosclerosis (p <= 0.01). All RNA viruses in this study are linked to atherosclerosis, except HCV (OR: 1.08; CI: 0.28-4.16; p=0.94). Conclusion, significance and impact of study: The outcomes from this systematic review indicate that multiple viral agents may contribute to the pathophysiology of atherosclerosis. Thus, controlling viral infection is crucial, particularly in individuals with atherosclerosis risk factors, to mitigate their risk.