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The coronary relationship between infection and cardiovascular disease is likely to have several mediators (including possibly an autoimmune response against protein on the arterial coronary endothelial cell wall) [58]. Cigarette smoking is a well established cardiovascular disease risk factor [59–64], as is high body mass index (BMI) [60], both providing a link between increased inflammation and increased risk. Although regular exercise reduces the risk of cardiovascular events, severe exercise has been shown to be associated with a systemic inflammatory response [65] and increased risk of myocardial infarction [66,67]. In contrast to coronary the risks of severe exercise, moderate exercise and physical fitness are associated with lower baseline levels of inflammatory mediators [62,65,68–70]. Inflammatory markers such as C-reactive protein and fibrinogen are raised in affected people in both chronic coronary artery disease [60,62,63] and peripheral vascular disease compared with unaffected people [71].
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