Elevated Chlamydia pneumoniae Antibodies, Cardiovascular Events, and Azithromycin in Male Survivors of Myocardial Infarction
| Autor: | S Gupta, D. Carrington, Michael A. Mendall, A. J. Camm, Juan Carlos Kaski, E Leatham |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Administration Oral Azithromycin Placebo Gastroenterology law.invention Randomized controlled trial law Physiology (medical) Internal medicine medicine Humans Myocardial infarction Aged Chemotherapy Chlamydia business.industry Incidence (epidemiology) Odds ratio Chlamydia Infections Chlamydophila pneumoniae Middle Aged medicine.disease Antibodies Bacterial Anti-Bacterial Agents Immunology Cardiology and Cardiovascular Medicine business Biomarkers medicine.drug |
| Zdroj: | Circulation. 96:404-407 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/01.cir.96.2.404 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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