zithromax and Myocardial-Ischemia

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

Chlamydia pneumoniae is the third species of the genus Chlamydia and has been known to cause respiratory tract infections. Since the association between the seropositivity of C. pneumoniae and ischemic heart diseases was reported in 1988, the association between C. pneumoniae and atherosclerosis has been noteworthy. Positive findings of the association between C. pneumoniae and atherosclerosis have been reported as the result of seroepidemiological surveys, histological studies to detect C. pneumoniae in human atherosclerotic tissues, and animal infection models. These data supported that C. pneumoniae infection occurs in human vascular walls and may accelerate the foam cell formation of macrophage and smooth muscle cells, and may play a causative role in atherosclerosis. Several large-scale studies of the antimicrobial prevention of secondary cardiac events are in progress. The genome projects for C. pneumoniae have recently been reported. A number of issues remain unclear, however, and further intensive research is necessary.

Topics: Adult; Aged; Animals; Anti-Bacterial Agents; Arteriosclerosis; Azithromycin; Chlamydia Infections; Chlamydophila pneumoniae; Cholesterol; Clinical Trials as Topic; Endothelium, Vascular; Foam Cells; Genome, Bacterial; Humans; Macrophages; Mice; Mice, Transgenic; Middle Aged; Muscle, Smooth, Vascular; Myocardial Ischemia; Pneumonia, Bacterial; Rabbits; Seroepidemiologic Studies

Effect of therapy with azithromycin and doxycycline on lipid metabolism, processes of lipid peroxidation and state of antioxidant defense was studied in patients with ischemic heart disease with elevated titer of antibodies to Chlamydia Pneumonia. Therapy with azithromycin (500 mg/day for 2 months) was associated with lowering of antibody titer, moderate improvement of lipid spectrum, marked decrease of activity of lipid peroxidation and augmentation of blood plasma antioxidant reserve. There were no such changes in a group of doxycycline treated patients. This difference can be attributed to more pronounced antimicrobial activity of azithromycin against Chlamydophila Pneumonia and its intrinsic antioxidant properties.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Antioxidants; Azithromycin; Chlamydophila Infections; Chlamydophila pneumoniae; Data Interpretation, Statistical; Doxycycline; Female; Humans; Lipid Metabolism; Lipid Peroxidation; Male; Middle Aged; Myocardial Ischemia; Pneumonia, Bacterial; Time Factors