This Article Full Text Full Text (PDF) All Versions of this Article: 105/11/1298    most recent hc1102.105649v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Parchure, N. Articles by Kaski, J. C. Search for Related Content PubMed PubMed Citation Articles by Parchure, N. Articles by Kaski, J. C. Related Collections Pathophysiology Other arteriosclerosis Other Treatment Chronic ischemic heart disease Endothelium/vascular type/nitric oxide

(Circulation. 2002;105:1298.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Effect of Azithromycin Treatment on Endothelial Function in Patients With Coronary Artery Disease and Evidence of Chlamydia pneumoniae Infection

Nikhil Parchure, MRCP; Emmanouil G. Zouridakis, MD; Juan Carlos Kaski, MD, DSc, FRCP

From the Department of Cardiological Sciences, St George’s Hospital Medical School, Cranmer Terrace, London, UK.

Correspondence to Prof Juan Carlos Kaski, Coronary Artery Disease Research Unit, Department of Cardiological Sciences, St George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. E-mail jkaski{at}sghms.ac.uk

Background— It has been suggested that infection with Chlamydia pneumoniae(CPn) can trigger inflammatory mechanisms that may in turn impair vascular endothelial function. The aim of the present study was to assess whether treatment with the macrolide antibiotic azithromycin improves endothelial function in patients with coronary artery disease and antibodies positive to CPn.

Methods and Results— We carried out a randomized, prospective, double-blind, placebo-controlled trial in 40 male patients (mean age, 55±9 years) with documented coronary artery disease and positive CPn-IgG antibody titers. After baseline evaluation, patients were randomized to receive either azithromycin or placebo for 5 weeks. Flow-mediated dilation (FMD) of the brachial artery and E-selectin, von Willebrand factor, and C-reactive protein (CRP) levels were assessed at study entry and at the end of the treatment period. Our results showed that patients who received azithromycin had a significant improvement in FMD (mean change, 2.1±1.1%; P<0.005). In contrast, FMD was not significantly changed in the placebo group (mean change, -0.02±0.2%, P=0.64). Azithromycin therapy also resulted in a significant decrease of E-selectin and von Willebrand factor levels. CRP levels were not significantly altered by treatment with either azithromycin or placebo. Beneficial effects of azithromycin treatment were independent from the presence of low (<1:32) or high (1:32) CPn antibody titers.

Conclusions— Our findings indicate that treatment with azithromycin has a favorable effect on endothelial function in patients with documented coronary artery disease and evidence of CPn infection irrespective of antibody titer levels. Whether these favorable actions of antibiotic treatment will translate into a beneficial effect on atherogenesis and cardiac events needs further investigation.

Key Words: infection • endothelium • cell adhesion molecules • von Willebrand factor

This article has been cited by other articles:

				F. Violi, V. Sanguigni, R. Carnevale, A. Plebani, P. Rossi, A. Finocchi, C. Pignata, D. De Mattia, B. Martire, M. C. Pietrogrande, et al. Hereditary Deficiency of gp91phox Is Associated With Enhanced Arterial Dilatation: Results of a Multicenter Study Circulation, October 20, 2009; 120(16): 1616 - 1622. [Abstract] [Full Text] [PDF]

				M. Bosnar, B. Bosnjak, S. Cuzic, B. Hrvacic, N. Marjanovic, I. Glojnaric, O. Culic, M. J. Parnham, and V. E. Haber Azithromycin and Clarithromycin Inhibit Lipopolysaccharide-Induced Murine Pulmonary Neutrophilia Mainly through Effects on Macrophage-Derived Granulocyte-Macrophage Colony-Stimulating Factor and Interleukin-1{beta} J. Pharmacol. Exp. Ther., October 1, 2009; 331(1): 104 - 113. [Abstract] [Full Text] [PDF]

				S. Amar, S.-c. Wu, and M. Madan Is Porphyromonas gingivalis Cell Invasion Required for Atherogenesis? Pharmacotherapeutic Implications J. Immunol., February 1, 2009; 182(3): 1584 - 1592. [Abstract] [Full Text] [PDF]

				I. Volanen, K. Kallio, M. Saarinen, M. J. Jarvisalo, R. Vainionpaa, T. Ronnemaa, J. Viikari, J. Marniemi, O. Simell, and O. T. Raitakari Arterial Intima-Media Thickness in 13-Year-Old Adolescents and Previous Antichlamydial Antimicrobial Use: A Retrospective Follow-up Study Pediatrics, September 1, 2008; 122(3): e675 - e681. [Abstract] [Full Text] [PDF]

				W. L. Baker and K. A. Couch Azithromycin for the secondary prevention of coronary artery disease: A meta-analysis Am. J. Health Syst. Pharm., April 15, 2007; 64(8): 830 - 836. [Abstract] [Full Text] [PDF]

				R. Andraws, J. S. Berger, and D. L. Brown Effects of Antibiotic Therapy on Outcomes of Patients With Coronary Artery Disease: A Meta-analysis of Randomized Controlled Trials JAMA, June 1, 2005; 293(21): 2641 - 2647. [Abstract] [Full Text] [PDF]

				B. J. Wells, A. G. Mainous III, and L. M. Dickerson Antibiotics for the Secondary Prevention of Ischemic Heart Disease: A Meta-analysis of Randomized Controlled Trials Arch Intern Med, October 25, 2004; 164(19): 2156 - 2161. [Abstract] [Full Text] [PDF]

				B. Ludewig, P. Krebs, and E. Scandella Immunopathogenesis of atherosclerosis J. Leukoc. Biol., August 1, 2004; 76(2): 300 - 306. [Abstract] [Full Text] [PDF]

				J.-C. Kaski, P. Khairy, S. Rinfret, J.-C. Tardif, R. Marchand, S. Shapiro, J. Brophy, and J. Dupuis Infection, Endothelial Dysfunction, and Atherogenesis * Response Circulation, December 23, 2003; 108 (25): e171 - e172. [Full Text] [PDF]

				C. M. O'Connor, M. W. Dunne, M. A. Pfeffer, J. B. Muhlestein, L. Yao, S. Gupta, R. J. Benner, M. R. Fisher, and T. D. Cook Azithromycin for the Secondary Prevention of Coronary Heart Disease Events: The WIZARD Study: A Randomized Controlled Trial JAMA, September 17, 2003; 290(11): 1459 - 1466. [Abstract] [Full Text] [PDF]

				J. P. Higgins Chlamydia pneumoniae and Coronary Artery Disease: The Antibiotic Trials Mayo Clin. Proc., March 1, 2003; 78(3): 321 - 332. [Abstract] [PDF]

				P. Wiesli, G. Schulthess, J.C. Kaski, N. Parchure, and E. Zouridakis Effect of Roxithromycin Treatment on the Endothelial Function of Chlamydia pneumoniae Seropositive Men Suffering From Peripheral Arterial Occlusive Disease * Response Circulation, December 17, 2002; 106 (25): e226 - e226. [Full Text] [PDF]

				F.-J. Neumann Chlamydia pneumoniae-Atherosclerosis Link: A Sound Concept in Search for Clinical Relevance Circulation, November 5, 2002; 106(19): 2414 - 2416. [Full Text] [PDF]

				D. Sander, K. Winbeck, J. Klingelhofer, T. Etgen, and B. Conrad Reduced Progression of Early Carotid Atherosclerosis After Antibiotic Treatment and Chlamydia pneumoniae Seropositivity Circulation, November 5, 2002; 106(19): 2428 - 2433. [Abstract] [Full Text] [PDF]

				M. R. Hammerschlag, J.C. Kaski, N. Parchure, and E. Zouridakis Effect of Azithromycin on Endothelial Function of Patients With Coronary Artery Disease and Evidence of Chlamydia pneumoniae Infection * Response Circulation, October 8, 2002; 106 (15): e65 - e66. [Full Text] [PDF]

				J. A. Vita and J. Loscalzo Shouldering the Risk Factor Burden: Infection, Atherosclerosis, and the Vascular Endothelium Circulation, July 9, 2002; 106(2): 164 - 166. [Full Text] [PDF]