zithromax and Coronary-Artery-Disease

A meta-analysis of randomized, controlled trials that evaluated the effect of the macrolide antibiotic, azithromycin, on clinical outcomes in patients with coronary artery disease (CAD) was conducted.. A systematic literature search of MEDLINE, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews was conducted using specific search terms. Randomized, controlled trials comparing azithromycin or placebo in secondary CAD patients with adequately reported data on mortality and clinical cardiac endpoints were included. A random-effects model was used.. Six studies (n=13,778) met the inclusion criteria. The trials varied in their design. On meta-analysis, azithromycin resulted in a nonsignificant reduction in mortality versus placebo (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.77-1.09; p=0.31). Four trials reported the rate of nonfatal myocardial infarction (MI). Azithromycin did not have an effect on the rate of nonfatal MI versus placebo (OR, 0.95; 95% CI, 0.80-1.13; p=0.57). Five trials reported rates of hospitalization in which no significant difference was seen with azithromycin versus placebo (OR, 0.97; 95% CI, 0.80-1.17; p=0.76). Six trials were used to evaluate the composite cardiovascular endpoint. Again, no significant benefit was seen with azithromycin versus placebo (OR, 0.93; 95% CI, 0.84-1.03; p=0.218).. Meta-analysis showed that azithromycin does not appear to reduce the frequency of recurrent cardiac events in patients with CAD. Results from ongoing trials may clarify the role of azithromycin in the secondary prevention of coronary events.

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydophila Infections; Chlamydophila pneumoniae; Coronary Artery Disease; Hospitalization; Humans; Models, Statistical; Myocardial Infarction; Randomized Controlled Trials as Topic

Several lines of evidence have demonstrated an association between a variety of chronic bacterial infections and atherosclerotic cardiovascular disease. This has led to the proposal that antibiotic therapy might be helpful in the secondary prevention of atherosclerosis. A variety of smaller pilot studies have been reported testing this hypothesis and several large multicenter trials are also underway. The purpose of this review is to summarize the results of these studies and comment on their implications for the treatment of atherosclerosis.. Most of the antibiotic studies to date have been secondary prevention studies that have targeted patients exposed to Chlamydia pneumoniae. Most have used either azithromycin or roxithromycin with treatment courses ranging from a few days to 3 months. Several small studies of coronary artery disease patients have shown significant promise for reducing cardiovascular events such as death, myocardial infarction, or admission for unstable angina. However, other studies have not been so positive. Weekly Intervention with Zithromax for Atherosclerosis and its Related Disorders, WIZARD, the largest study to date, in which stable post-myocardial infarction patients were randomized to receive a 3-month course of azithromycin or placebo, demonstrated a significant reduction in death and myocardial infarction by 6 months, but this benefit was not sustained throughout the remaining course of follow-up. The Azithromycin and Coronary Events (ACES) and Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT) trials are ongoing and are testing the effect of more prolonged treatment duration.. A variety of antibiotic trials for the secondary prevention of atherosclerosis have been performed. Several pilot studies have shown significant positive clinical effects, but, thus far, no large randomized trial has confirmed those findings. Some concerns over the antibiotics chosen and the duration of treatment have been raised. Other trials are underway to address some of those concerns. In the meantime, no recommendation for the use of antibiotic therapy for the secondary prevention of atherosclerosis can yet be made.

Topics: Animals; Anti-Bacterial Agents; Arteriosclerosis; Azithromycin; C-Reactive Protein; Cardiovascular Diseases; Chlamydophila Infections; Chlamydophila pneumoniae; Clarithromycin; Coronary Artery Disease; Coronary Restenosis; Diet, Atherogenic; Fluoroquinolones; Gatifloxacin; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Models, Animal; Myocardial Ischemia; Rabbits; Randomized Controlled Trials as Topic; Roxithromycin; Treatment Outcome

This study examined the effect of azithromycin therapy on the coronary microcirculation using measurement of coronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography in 35 patients with coronary artery disease. CFVR increased significantly after azithromycin therapy (3.0 +/- 0.7 vs 3.5 +/- 0.7, p <0.001). The changes in CFVR were negatively correlated with changes in high-sensitivity C-reactive protein levels in patients receiving azithromycin.

Topics: Aged; Anti-Bacterial Agents; Azithromycin; C-Reactive Protein; Coronary Artery Disease; Coronary Vessels; Double-Blind Method; Echocardiography; Female; Humans; Male; Middle Aged; Myocardium; Prospective Studies; Regional Blood Flow

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Chlamydophila Infections; Chlamydophila pneumoniae; Coronary Artery Disease; Double-Blind Method; Drug Administration Schedule; Endothelium, Vascular; Female; Hemodynamics; Humans; Male; Middle Aged; Peripheral Vascular Diseases; Time Factors

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.. 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 (> or =1:32) CPn antibody titers.. 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.

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Biomarkers; Blood Flow Velocity; Brachial Artery; C-Reactive Protein; Chlamydophila Infections; Coronary Artery Disease; Double-Blind Method; E-Selectin; Endothelium, Vascular; Humans; Male; Middle Aged; Prospective Studies; Serologic Tests; Treatment Outcome; Ultrasonography; Vascular Patency; Vasodilation; von Willebrand Factor

Mounting evidence supports the contention that atherosclerosis is an inflammatory disease. Recently a possible role for infectious microorganisms has gathered attention. Chlamydia pneumoniae is one possible pathogen. If C. pneumoniae is a target organism, antibiotics with antichlamydial activity may be able to ameliorate plaque instability. The WIZARD trial is a secondary prevention study that is assessing the impact of a 3-month course of azithromycin compared with placebo on the progression of clinical coronary heart disease. The study will enroll 3300 patients who have had a prior myocardial infarction and who have a C. pneumoniae IgG titer of >/=1:16. The primary end point is a composite of time to either recurrent myocardial infarction, death, a revascularization procedure, or hospitalization for angina. This study is the first of a series of adequately powered clinical trials that will attempt to bridge insights from preclinical investigations to interventions applicable to patient care.

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydophila pneumoniae; Coronary Artery Disease; Coronary Disease; Humans; Myocardial Infarction; Randomized Controlled Trials as Topic; Research Design; Treatment Outcome

We aimed to investigate the factors affecting the mortality of patients aged 65 years or older who were hospitalized with the diagnosis of new coronavirus pneumonia (COVID-19).. This is a retrospective study of patients 65 years old or older with COVID-19 who were hospitalized in İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Hospital, between March 11 and May 28, 2020. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records. We used univariate and multivariate logistic regression methods to explore the risk factors for in-hospital death.. A total of 218 patients (112 men, 106 women) were included, of whom 166 were discharged and 52 died in hospital. With univariate analysis, various clinical features and laboratory variables were found to be significantly different (i.e. P < 0.05). In multivariate logistic regression analysis the following were independently associated with mortality: present malignancy [odds ratio (OR) = 4.817, 95% confidence interval (CI) = 1.107–20.958, P: 0.036]; dyspnea (OR = 4.652, 95% CI = 1.473–14.688, P: 0.009); neutrophil/lymphocyte ratio (NLR; OR = 1.097, 95% CI = 1.012–1.188, P: 0.025); the highest values of C-reactive protein (CRP; OR = 1.006, 95% CI = 1.000–1.012, P: 0.049), lactate dehydrogenase (LDH; OR = 1.002, 95% CI = 1.001–1.004, P: 0.003), and creatinine levels (OR = 1.497, 95% CI = 1.126–1.990, P: 0.006); oxygen saturation (SpO2) values on admission (OR = 0.897, 95% CI = 0.811–0.993, P: 0.036); and azithromycin use (OR = 0.239, 95% CI = 0.065–0.874, P: 0.031).. The presence of malignancy; symptoms of dyspnea; high NLR; highest CRP, LDH, and creatinine levels; and low SpO2 on admission predicted mortality. On the other hand, azithromycin use was found to be protective against mortality. Knowing the causes predicting mortality will be important to treat future cases more successfully.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; C-Reactive Protein; Comorbidity; Coronary Artery Disease; COVID-19; Creatinine; Diabetes Mellitus, Type 2; Dyspnea; Female; Heart Failure; Humans; Hypertension; Hypoxia; L-Lactate Dehydrogenase; Leukocyte Count; Lymphocyte Count; Male; Neoplasms; Neutrophils; Prognosis; Pulmonary Disease, Chronic Obstructive; Risk Factors; SARS-CoV-2; Severity of Illness Index; Turkey

Topics: Anti-Bacterial Agents; Arrhythmias, Cardiac; Azithromycin; Clarithromycin; Coronary Artery Disease; Coronary Disease; Death, Sudden, Cardiac; Erythromycin; Humans; Macrolides; Plaque, Atherosclerotic; Risk Factors; Torsades de Pointes

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydophila Infections; Chlamydophila pneumoniae; Coronary Artery Disease; Fluoroquinolones; Gatifloxacin; Humans; Myocardial Infarction; Treatment Failure

Topics: Azithromycin; Chlamydophila Infections; Chlamydophila pneumoniae; Coronary Artery Disease; Female; France; Humans; Male; Microbial Sensitivity Tests; Platelet Aggregation Inhibitors; Primary Prevention; Prognosis; Resveratrol; Risk Assessment; Stilbenes; United States; Wine

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Chlamydophila Infections; Chlamydophila pneumoniae; Coronary Artery Disease; Endothelium, Vascular; Humans; Serologic Tests

Topics: Azithromycin; Brachial Artery; C-Reactive Protein; Chlamydophila Infections; Coronary Artery Disease; E-Selectin; Humans; Randomized Controlled Trials as Topic; Vasodilation; von Willebrand Factor