Could Lyme disease and other tick-borne infections be overlooked contributors to arterial inflammation, heart disease, and stroke risk?

In this LIVE from ILADS interview, Tick Boot Camp co-host Rich reconnects with Dr. H. Thomas “Tom” Hight, MD, a board-certified internal medicine physician and clinical lipidologist specializing in cardiovascular disease prevention and arterial health.

Recorded at the 2025 International Lyme and Associated Diseases Society (ILADS) Conference in San Antonio, Texas, the conversation explores a provocative question: Could certain infections contribute to cardiovascular inflammation in ways that conventional heart disease evaluations don’t routinely investigate?

Dr. Hight shares observations from his Atlanta-based practice, where he monitors arterial health using serial ultrasound examinations and cardiovascular biomarkers.

He describes patients whose arterial measurements worsened despite improvements in traditional risk factors, prompting him to investigate additional possible contributors, including chronic viral infections and tick-borne illnesses.

The discussion covers Lyme disease, Bartonella, endothelial inflammation, atherosclerosis, plaque regression, heart attacks, strokes, Lyme carditis, and emerging research into vascular health and dementia.

Dr. Hight also explains why he believes cardiovascular prevention should look beyond cholesterol and blood pressure while emphasizing the importance of addressing all relevant risk factors.

His observations raise important research questions, although a direct causal relationship between persistent tick-borne infection and coronary atherosclerosis has not been established.

Meet Dr. Tom Hight, MD

Dr. H. Thomas Hight, MD is a physician specializing in cardiovascular risk reduction, arterial disease, and clinical lipidology.

Based in Atlanta, Georgia, he has spent years working with patients who have experienced heart attacks, strokes, and other serious cardiovascular events.

Dr. Hight developed an ultrasound-based approach to monitoring changes in arterial health over time.

His practice, CardioSound, focuses on identifying and addressing factors that may contribute to cardiovascular disease progression.

His growing interest in Lyme disease began after observing unexpected changes in patients whose cardiovascular risk factors appeared to be improving.

He attended an ILADS conference in Boston to learn more about tick-borne illnesses and their possible cardiovascular implications.

This interview follows his earlier appearance on Tick Boot Camp, where he first discussed the potential relationship between Lyme disease and cardiovascular risk.

Why Dr. Hight Started Investigating Lyme Disease in Heart Patients

Dr. Hight explains that his practice regularly monitors patients who have already experienced cardiovascular events.

These patients face increased risks of subsequent heart attacks, strokes, and other complications.

His approach includes repeat arterial ultrasound studies approximately every three to four months, alongside laboratory testing and comprehensive risk-factor management.

He looks for evidence that arterial disease is stabilizing or improving.

However, following the COVID-19 pandemic, he noticed an unexpected pattern.

Some patients who had previously shown improvements began experiencing worsening arterial findings.

This prompted him to reconsider whether additional inflammatory or infectious factors might be contributing to their cardiovascular risk.

He began evaluating selected patients for chronic viral illnesses and tick-borne infections.

Dr. Hight reports that some patients subsequently showed improvements in inflammatory biomarkers and arterial measurements during treatment.

These observations motivated his continued interest in the relationship between infectious disease and cardiovascular health.

Lyme Disease, Bartonella, and Endothelial Inflammation

A central theme of the conversation is the endothelium, the thin layer of cells lining the inside of blood vessels.

Endothelial cells play important roles in vascular function, blood flow, inflammation, and clotting.

Dr. Hight discusses how certain infections may affect vascular tissues and potentially contribute to inflammatory processes.

He is particularly interested in Borrelia, the bacteria responsible for Lyme disease, and Bartonella species.

Both infections have recognized cardiovascular manifestations under certain circumstances, although their mechanisms and clinical presentations differ.

Dr. Hight believes further research is needed to determine whether some tick-borne infections contribute to the progression of atherosclerosis.

Does Treating Infections Improve Arterial Health?

Dr. Hight reports observing reductions in inflammatory biomarkers followed by improvements in arterial ultrasound findings among some patients receiving treatment.

He emphasizes that infection management is only one part of his cardiovascular approach.

His patients also receive attention to cholesterol, blood pressure, metabolic health, and other established cardiovascular risk factors.

Because multiple interventions may occur together, these clinical observations cannot determine which intervention caused the improvements.

Dr. Hight acknowledges that more research is necessary to establish cause-and-effect relationships.

Understanding Atherosclerosis and Plaque Regression

Atherosclerosis develops when plaque accumulates within artery walls.

Plaque contains lipids, inflammatory cells, connective tissue, and other materials.

Over time, atherosclerosis can restrict blood flow or contribute to events such as heart attacks and strokes.

Dr. Hight explains that he uses repeated ultrasound studies to evaluate changes in arterial disease.

He discusses plaque regression, which refers to a reduction in atherosclerotic plaque burden.

He believes monitoring arterial changes over time provides valuable information about whether a patient’s cardiovascular risk-management plan is working.

Although plaque regression can occur with effective treatment, interpreting ultrasound changes requires appropriate measurement techniques and clinical context.

Dr. Hight also describes strong survival outcomes in his own practice. These are self-reported clinical observations, not independently verified results from a controlled study.

Beyond Cholesterol: More Than 20 Modifiable Heart Disease Risk Factors

Dr. Hight argues that cardiovascular medicine should consider a wider range of potentially modifiable risk factors.

He explains that many routine discussions focus primarily on:

• Cholesterol
• Blood pressure
• Diabetes
• Smoking
• Obesity

These are important, well-established cardiovascular risk factors.

However, Dr. Hight believes clinicians should also investigate other contributors when patients experience unexpected disease progression.

He describes evaluating more than 20 modifiable factors in his practice.

His broader approach includes inflammatory markers and, in selected circumstances, possible infectious contributors.

The conversation emphasizes that patients who have experienced a heart attack or stroke benefit from comprehensive secondary prevention, including evidence-based medication, lifestyle management, and appropriate specialist follow-up.

Cardiovascular Biomarkers: Troponin T, NT-proBNP, and IL-6

Dr. Hight discusses several laboratory markers that helped prompt his investigation into additional inflammatory processes.

These include:

High-sensitivity troponin T: A biomarker associated with heart muscle injury. Interpretation depends on the clinical situation and the degree and pattern of elevation.

NT-proBNP: A biomarker commonly used in the evaluation of heart failure and cardiac stress.

Interleukin-6 (IL-6): An inflammatory signaling molecule involved in immune responses and multiple disease processes.

Dr. Hight reports seeing changes in certain markers alongside changes in arterial health.

He believes these measurements may provide clues when investigating patients whose cardiovascular disease is not improving as expected.

However, these biomarkers are not specific tests for Lyme disease, Bartonella infection, or infection-related atherosclerosis.

Lyme Carditis vs. Coronary Artery Disease

Rich and Dr. Hight discuss the distinction between established cardiac complications of Lyme disease and the broader possibility of infection-associated atherosclerosis.

Lyme carditis is a recognized manifestation of Lyme disease that can affect the heart’s electrical conduction system, sometimes causing atrioventricular block.

Symptoms may include palpitations, dizziness, fainting, shortness of breath, and chest discomfort.

Coronary artery disease is different.

It generally involves atherosclerotic plaque buildup in arteries supplying the heart muscle.

Dr. Hight believes more research should investigate whether tick-borne infections contribute to coronary artery disease in selected patients.

However, Lyme carditis does not establish that Lyme disease is a common cause of atherosclerosis.

For a related conversation, listen to Tick Boot Camp’s interview with Dr. Medeya Tsnobiladze about the neurological and cardiovascular impacts of Lyme disease.

Should Heart Attack Patients Be Tested for Lyme Disease?

Rich asks whether tick-borne disease testing should become part of routine cardiovascular evaluations.

Dr. Hight believes infectious contributors deserve more consideration, particularly when a patient’s clinical history raises relevant questions.

He acknowledges that evidence establishing the relationship between Lyme disease and atherosclerosis remains incomplete.

Currently, routine Lyme disease testing for every heart attack patient is not an established standard of care.

Testing decisions should consider symptoms, possible tick exposure, geographic risk, and the likelihood that results will meaningfully guide medical management.

The discussion also addresses the financial burden of specialty testing and the importance of determining whether additional tests offer meaningful clinical value.

Do Patients Always Need Coronary Stents?

Dr. Hight discusses the role of coronary stents in treating certain forms of heart disease.

He acknowledges that stents can be lifesaving when appropriately used.

However, he questions whether some patients with stable coronary artery disease undergo procedures that may not improve their long-term outcomes.

He references two major clinical trials:

COURAGE Trial: Investigated optimal medical therapy with or without percutaneous coronary intervention in selected patients with stable coronary artery disease.

ISCHEMIA Trial: Compared an initial invasive strategy with a conservative strategy in patients with stable ischemic heart disease.

These studies helped clarify the benefits and limitations of invasive procedures in particular patient populations.

The findings do not mean stents are unnecessary for all patients without symptoms or that medical treatment can replace urgent intervention during a heart attack.

Treatment decisions depend on the patient’s clinical condition, coronary anatomy, symptoms, and overall risk.

Could Vascular Inflammation Contribute to Dementia?

Near the end of the interview, Dr. Hight discusses his interest in the relationship between large-vessel disease, small-vessel disease, and cognitive health.

He explains that vascular problems can affect both the heart and brain.

Large-vessel disease can contribute to heart attacks and strokes, while cerebral small-vessel disease can contribute to cognitive impairment and vascular dementia.

Dr. Hight hopes future research will identify better biomarkers and interventions that help clinicians recognize and manage vascular disease earlier.

He raises the possibility that improved understanding of inflammatory mechanisms could benefit both cardiovascular and neurological health.

This is a research goal, not evidence that treating Lyme disease reverses dementia.

The Future: Better Biomarkers, Research, and Prevention

Dr. Hight hopes to continue studying the potential relationship between tick-borne infections and cardiovascular disease.

He expresses interest in presenting his clinical observations at a future ILADS conference.

His broader goal is to develop better tools that help healthcare professionals identify risk factors, monitor arterial health, and intervene before serious cardiovascular events occur.

Rich encourages him to share his findings with the wider medical community.

Both agree that research, collaboration, and education are essential for answering questions about the possible cardiovascular consequences of tick-borne infections.

Key Takeaways

• Lyme disease has recognized cardiac complications. Lyme carditis can affect the heart’s electrical conduction system.
• The relationship between Lyme disease and atherosclerosis remains uncertain. Dr. Hight’s clinical observations raise questions that require controlled research.
• Endothelial health matters. The inner lining of blood vessels plays a central role in vascular function and inflammation.
• Heart disease prevention involves multiple risk factors. Cholesterol, blood pressure, diabetes, smoking, and other established risks remain essential treatment targets.
• Serial arterial imaging may help monitor selected patients. Dr. Hight uses ultrasound to evaluate changes in arterial disease over time.
• Biomarkers can provide important clinical information. Troponin T, NT-proBNP, and IL-6 have different uses and limitations.
• Coronary stents have an important but specific role. Their benefits depend on the clinical situation.
• Vascular health and cognitive health are connected. Research into cerebral small-vessel disease may improve understanding of vascular dementia.
• Further research is needed. Dr. Hight hopes to investigate whether selected tick-borne infections contribute to cardiovascular disease progression.

About This LIVE from ILADS Interview

Recorded at the 2025 International Lyme and Associated Diseases Society Conference in San Antonio, Texas, this interview reunites Rich with Dr. Tom Hight for an update on his clinical observations and cardiovascular research interests.

The conversation explores Lyme disease, Bartonella, arterial inflammation, atherosclerosis, heart attack prevention, plaque regression, and the possibility of improved vascular health through comprehensive risk-factor management.

Explore additional interviews with healthcare professionals and researchers through Tick Boot Camp’s LIVE from ILADS podcast series.