At the International Lyme and Associated Diseases Society’s (ILADS) 19th Annual Conference in Chicago in early November, Dr. Gerber presented the full spectrum of cardiovascular manifestations of Lyme disease and common co-infections, proposing that infection may be a precursor for systemic inflammation and coagulation resulting in “atherogenic” cardiovascular disease, and that high cholesterol is not the cause of “atherosclerotic” heart disease, replacing “the diet-heart hypothesis.”  

The ILADS conference theme this year was tick-borne diseases and the immune system. Multiple speakers highlighted the changing complexion of Lyme disease from a single bug with choice for a single antibiotic to a more complicated disease process of multiple pathogens, some acute and some perhaps more chronic. Patients with Lyme disease often present with multifaceted symptoms, often related to bioindividual genetic variants. This requires us to adopt a whole new approach to the diagnosis and therapy of tick-borne diseases.

There are genetic predispositions with which we are all born, and then there are environmental factors which cause general health decline (the immune system often gets overworked, then suppressed). A “trigger” may be one or more pathogens, or a toxin and pathogens, or multiple combinations of those. The individual patient will manifest the disease process based on those factors unique to the patient’s immune response: bioindividuality.

Although the diversity of the responses in the heart and blood vessels has been reported, this realm of cardiology has not become widely recognized or appreciated. The long term consequences of chronic infection with tick borne diseases and the burden of associated opportunistic infections on the cardiovascular system remain unmeasured.

In this interview recorded during the 2018 ILADS conference in Chicago, Dr. Gerber discusses the strategies for diagnosis and management of Lyme disease — as a complex cardiology problem.