Circulation. 1998;97:1669-1670
(Circulation. 1998;97:1669-1670.)
© 1998 American Heart Association, Inc.
Antibiotic Treatment of Chlamydia pneumoniae for Secondary Prevention of Cardiovascular Events
J. Thomas Grayston, MD
From the Department of Epidemiology, University of Washington, Seattle.
Correspondence to J. Thomas Grayston, MD, Professor of Epidemiology, University of Washington, F263 Health Sciences Center, Seattle, WA 98195-7236.
Key Words: Editorials • Chlamydia pneumoniae • antibodies • antibiotics
Since the publication
of two preliminary antibiotic treatment trials for
secondary prevention of cardiovascular events in
persons with coronary artery disease
(CAD),1 2 there has been increased interest in
the possibility that the association between Chlamydia
pneumoniae and atherosclerosis is causal and that
antibiotic treatment can have a favorable effect on the complications
and outcome of the disease. The impetus for these trials was the
repeated demonstration by many investigators of an association of
C pneumoniae and atherosclerosis by both
seroepidemiology and demonstration of the
organism in atherosclerotic lesions. A number of antibiotic treatment
trials to evaluate reduction in cardiac events are being planned or
initiated in many different countries. Adequately sized and properly
designed trials are both desirable and justified. Two of the difficult
questions in planning such trials are the inclusion criteria for
subjects and the appropriate length of treatment.
In choosing the subjects, one consideration is the expected rate of
end-point events: cardiovascular death, myocardial
infarction (MI), and defined episodes of unstable angina. A trial with
a higher event rate will require fewer subjects and a shorter
observation period. The results will be applicable only to the
higher-risk patient. This is exemplified by the trial in Buenos
Aires2 in which hospitalized patients with unstable angina
and non–Q-wave MI were studied. Although this is an important study
that could aid many patients, evaluation of antibiotic treatment of
patients with stable CAD will have even wider applicability. A
surprising finding in the London study,1 which used stable
post-MI patients, is . . . [Full Text of this Article]
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