(Circulation. 1997;96:404-407.)
© 1997 American Heart Association, Inc.
Articles |
Elevated Chlamydia pneumoniae Antibodies, Cardiovascular Events, and Azithromycin in Male Survivors of Myocardial Infarction
From the Departments of Cardiological Sciences (S.G., E.W.L., J.C.K., A.J.C.), Virology (D.C.), and Medicine (M.A.M.), St George's Hospital Medical School, London, UK.
Correspondence to Dr Sandeep Gupta, BHF Cardiology Research Fellow, Department of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, Tooting, London SW17 ORE, UK.
Background The clinical significance of the association between elevated anti–Chlamydia pneumoniae (Cp) antibody titres and coronary heart disease (CHD) is unclear. We explored the relationship between antibodies against Cp and future cardiovascular events in male survivors of myocardial infarction (MI). The effect of azithromycin antibiotic therapy was assessed in a subgroup of post-MI patients.
Methods and Results We screened 220 consecutive male
survivors of MI for anti-Cp antibodies. Of these, 213 patients were
stratified into three groups: group Cp-ve (n=59), no detectable Cp
antibodies; group Cp-I (n=74), intermediate titres of 1/8 to 1/32
dilution; and group Cp+ve (n=80), seropositive at 
1/64 dilution.
Patients with persisting seropositivity of 1/64 were randomized to
either oral azithromycin (Cp+ve-A, 500 mg/d for 3 days [n=28] or 500
mg/d for 6 days [n=12]) or placebo (Cp+ve-P, n=20). Cp+ve-NR (n=20)
represented patients not recruited into the antibiotic
trial. The incidence of adverse cardiovascular events
(over a mean follow-up period of 18±4 months) was recorded and
shown to increase with increasing anti-Cp titre: Cp-ve, n=4 (7%);
Cp-I, n=11 (15%); Cp+ve-NR, n=6 (30%); and Cp+ve-P, n=5 (25%).
Cp+ve-NR and Cp+ve-P groups had a fourfold-increased risk for adverse
cardiovascular events compared with the Cp-ve group
(odds ratio [OR], 4.2; 95% confidence interval [CI], 1.2 to 15.5;
P=.03). In contrast, the OR for
cardiovascular events in patients receiving
azithromycin (Cp+ve-A, single or double course) was the same as in the
Cp-ve group (OR, 0.9; 95% CI, 0.2 to 4.6, P=NS). Patients
receiving azithromycin were more likely to experience a decrease in IgG
anti-Cp titres than were those in the placebo group
(P=.02).
Conclusions An increased anti-Cp antibody titre may be a predictor for further adverse cardiovascular events in post-MI patients. Taking a short course of azithromycin may lower this risk, possibly by acting against Cp.
Key Words: Chlamydia pneumoniae • antibodies • myocardial infarction • azithromycin
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 P. Vehmaan-Kreula, M. Puolakkainen, M. Sarvas, H. G. Welgus, and P. T. Kovanen Chlamydia pneumoniae Proteins Induce Secretion of the 92-kDa Gelatinase by Human Monocyte- Derived Macrophages Arterioscler Thromb Vasc Biol, January 1, 2001; 21 (1): e1 - e8. [Abstract] [Full Text] [PDF]
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R.R Azar, S Rinfret, P Theroux, P.H Stone, R Dakshinamurthy, Y.-J Feng, A.H.B Wu, G Range, and D.D Waters A randomized placebo-controlled trial to assess the efficacy of antiinflammatory therapy with methylprednisolone in unstable angina (MUNA trial) Eur. Heart J., December 2, 2000; 21(24): 2026 - 2032. [Abstract] [PDF]
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G. Y. H. Lip and A. D. Blann Thrombogenesis and fibrinolysis in acute coronary syndromes: Important facets of a prothrombotic or hypercoagulable state? J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2044 - 2046. [Full Text] [PDF]
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O. J. de Boer, A. C. van der Wal, M. A. Houtkamp, J. M. Ossewaarde, P. Teeling, and A. E. Becker Unstable atherosclerotic plaques contain T-cells that respond to Chlamydia pneumoniae Cardiovasc Res, December 1, 2000; 48(3): 402 - 408. [Abstract] [Full Text] [PDF]
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R. Kaul, J. Uphoff, J. Wiedeman, S. Yadlapalli, and W. M. Wenman Detection of Chlamydia pneumoniae DNA in CD3+ Lymphocytes From Healthy Blood Donors and Patients With Coronary Artery Disease Circulation, November 7, 2000; 102(19): 2341 - 2346. [Abstract] [Full Text] [PDF]
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J. T. Grayston Secondary Prevention Antibiotic Treatment Trials for Coronary Artery Disease Circulation, October 10, 2000; 102(15): 1742 - 1743. [Full Text] [PDF]
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J. B. Muhlestein, J. L. Anderson, J. F. Carlquist, K. Salunkhe, B. D. Horne, R. R. Pearson, T. J. Bunch, A. Allen, S. Trehan, and C. Nielson Randomized Secondary Prevention Trial of Azithromycin in Patients With Coronary Artery Disease : Primary Clinical Results of the ACADEMIC Study Circulation, October 10, 2000; 102(15): 1755 - 1760. [Abstract] [Full Text] [PDF]
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M.-T. Labro Interference of Antibacterial Agents with Phagocyte Functions: Immunomodulation or "Immuno-Fairy Tales"? Clin. Microbiol. Rev., October 1, 2000; 13(4): 615 - 650. [Abstract] [Full Text] [PDF]
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 F. Chierichetti, E. Arbustini, V. Arici, S. P. Moghadam, B. Conti, and A. Bagliani Identification of Chlamydia pneumoniae DNA in Carotid Plaques Angiology, October 1, 2000; 51(10): 827 - 830. [Abstract] [PDF]
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G. Caligiuri, G. Paulsson, A. Nicoletti, A. Maseri, and G. K. Hansson Evidence for Antigen-Driven T-Cell Response in Unstable Angina Circulation, September 5, 2000; 102(10): 1114 - 1119. [Abstract] [Full Text] [PDF]
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S A Morre, W Stooker, W K Lagrand, A J C van den Brule, and H W M Niessen Microorganisms in the aetiology of atherosclerosis J. Clin. Pathol., September 1, 2000; 53(9): 647 - 654. [Abstract] [Full Text] [PDF]
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K. K. Koh Effects of statins on vascular wall: vasomotor function, inflammation, and plaque stability Cardiovasc Res, September 1, 2000; 47(4): 648 - 657. [Abstract] [Full Text] [PDF]
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M. Mayr, S. Kiechl, J. Willeit, G. Wick, and Q. Xu Infections, Immunity, and Atherosclerosis : Associations of Antibodies to Chlamydia pneumoniae, Helicobacter pylori, and Cytomegalovirus With Immune Reactions to Heat-Shock Protein 60 and Carotid or Femoral Atherosclerosis Circulation, August 22, 2000; 102(8): 833 - 839. [Abstract] [Full Text] [PDF]
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 A. Fischer, D. E Gutstein, Z. A Fayad, and V. Fuster Predicting plaque rupture: enhancing diagnosis and clinical decision-making in coronary artery disease Vascular Medicine, August 1, 2000; 5(3): 163 - 172. [Abstract] [PDF]
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J. Danesh, P. Whincup, M. Walker, L. Lennon, A. Thomson, P. Appleby, Y.-k. Wong, M. Bernardes-Silva, M. Ward, and R. West Chlamydia pneumoniae IgG titres and coronary heart disease: prospective study and meta-analysis Commentary: Adjustment for potential confounders may have been taken too far BMJ, July 22, 2000; 321(7255): 208 - 213. [Abstract] [Full Text]
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 I. W. Fong Emerging relations between infectious diseases and coronary artery disease and atherosclerosis Can. Med. Assoc. J., July 1, 2000; 163(1): 49 - 56. [Abstract] [Full Text] [PDF]
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A.J. Camm and K.M. Fox Chlamydia pneumonia (and other infective agents) in atherosclerosis and acute coronary syndromes. How good is the evidence? Eur. Heart J., July 1, 2000; 21(13): 1046 - 1051. [PDF]
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M. S. V. Elkind, I-F. Lin, J. T. Grayston, and R. L. Sacco Chlamydia pneumoniae and the Risk of First Ischemic Stroke : The Northern Manhattan Stroke Study Stroke, July 1, 2000; 31(7): 1521 - 1525. [Abstract] [Full Text] [PDF]
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G. Liuzzo, J. J. Goronzy, H. Yang, S. L. Kopecky, D. R. Holmes, R. L. Frye, and C. M. Weyand Monoclonal T-Cell Proliferation and Plaque Instability in Acute Coronary Syndromes Circulation, June 27, 2000; 101(25): 2883 - 2888. [Abstract] [Full Text] [PDF]
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K. Ericson, T. G. P. Saldeen, O. Lindquist, C. Pahlson, and J. L. Mehta Relationship of Chlamydia pneumoniae Infection to Severity of Human Coronary Atherosclerosis Circulation, June 6, 2000; 101(22): 2568 - 2571. [Abstract] [Full Text] [PDF]
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X. X. Bin, K. Wolf, T. Schaffner, and R. Malinverni Effect of Azithromycin plus Rifampin versus Amoxicillin Alone on Eradication and Inflammation in the Chronic Course of Chlamydia pneumoniae Pneumonitis in Mice Antimicrob. Agents Chemother., June 1, 2000; 44(6): 1761 - 1764. [Abstract] [Full Text] [PDF]
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 D.S. GRIMES, E. HINDLE, and T. DYER Respiratory infection and coronary heart disease: progression of a paradigm QJM, June 1, 2000; 93(6): 375 - 383. [Abstract] [Full Text] [PDF]
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M. E. Rottenberg, A. Gigliotti Rothfuchs, D. Gigliotti, M. Ceausu, C. Une, V. Levitsky, and H. Wigzell Regulation and Role of IFN-{gamma} in the Innate Resistance to Infection with Chlamydia pneumoniae J. Immunol., May 1, 2000; 164(9): 4812 - 4818. [Abstract] [Full Text] [PDF]
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E. Gurfinkel, G. Bozovich, B. Mautner, J. L. Anderson, J. B. Muhlestein, J. Carlquist, A. Allen, S. Trehan, C. Nielson, S. Hall, et al. Chlamydia pneumoniae in Coronary Artery Disease • Response Circulation, March 28, 2000; 101 (12): e118 - e119. [Full Text] [PDF]
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E. Gurfinkel, G. Bozovich, and B. Mautner Chlamydia pneumoniae in Coronary Artery Disease Circulation, March 14, 2000; 101 (10): e95 - e95. [Full Text] [PDF]
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 K.J. Mattila, S. Asikainen, J. Wolf, H. Jousimies-Somer, V. Valtonen, and M. Nieminen Age, Dental Infections, and Coronary Heart Disease Journal of Dental Research, February 1, 2000; 79(2): 756 - 760. [Abstract] [PDF]
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 P. Ammann, S. Marschall, M. Kraus, L. Schmid, W. Angehrn, R. Krapf, and H. Rickli Characteristics and Prognosis of Myocardial Infarction in Patients With Normal Coronary Arteries Chest, February 1, 2000; 117(2): 333 - 338. [Abstract] [Full Text] [PDF]
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C. Bartels, M. Maass, G. Bein, N. Brill, J. F. M. Bechtel, R. Leyh, and H.-H. Sievers Association of Serology With the Endovascular Presence of Chlamydia pneumoniae and Cytomegalovirus in Coronary Artery and Vein Graft Disease Circulation, January 18, 2000; 101(2): 137 - 141. [Abstract] [Full Text] [PDF]
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B. Lorber Are All Diseases Infectious? Another Look Ann Intern Med, December 21, 1999; 131(12): 989 - 990. [Full Text]
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C. J. Wiedermann, S. Kiechl, S. Dunzendorfer, P. Schratzberger, G. Egger, F. Oberhollenzer, and J. Willeit Association of endotoxemia with carotid atherosclerosis and cardiovascular disease: Prospective results from the bruneck study J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1975 - 1981. [Abstract] [Full Text] [PDF]
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 T. Quaschning and C. Wanner The role of Chlamydia in coronary heart disease--fact or fiction? Nephrol. Dial. Transplant., December 1, 1999; 14(12): 2800 - 2803. [Full Text] [PDF]
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