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(Circulation. 2000;102:1742.)
© 2000 American Heart Association, Inc.

Editorial

Secondary Prevention Antibiotic Treatment Trials for Coronary Artery Disease

J. Thomas Grayston, MD

From the Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle.

Correspondence to Dr J. Thomas Grayston, Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Box 357236, Seattle, WA 98195.

Key Words: Editorials • coronary disease • antibiotics • Chlamydia pneumonia

Considerable interest was generated in the possible causative role of Chlamydia pneumoniae in coronary artery disease (CAD) by the publication of a small pilot study in London of antibiotic treatment of CAD that reduced coronary events.¹ Persons familiar with antibiotic treatment of chlamydia were skeptical that the brief treatment schedule in the London trial (azithromycin either one or two courses once daily for 3 days) could have a significant effect on chlamydia.² Because of the great importance of CAD and a possible new treatment, further human experimentation was justified. Anderson and coworkers³ and Muhlestein and colleagues⁴ at the LDS hospital and the University of Utah made a useful contribution by quickly undertaking a pilot study, Azithromycin in Coronary Artery Disease: Elimination of Myocardial Infection With Chlamydia (ACADEMIC), to see if the surprising findings of the English study could be repeated. It was important to perform this study because some cardiologists had begun inappropriate antibiotic treatment of patients after publication of the English study.

In the article by Muhlestein et al⁴ in this issue, we learn that no miraculous reduction in cardiovascular events was seen in 2 years after a more reasonable 3 months of antibiotic treatment. Whether the modest decrease (statistically not significant) in events in the treated group during the second year of observation indicates a treatment effect can be determined only in a larger study. It is important to emphasize, as did Muhlestein et al, that the ACADEMIC study was not adequately powered (not enough subjects) to prove . . . [Full Text of this Article]

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