The ACADEMIC study in perspective (Azithromycin in coronary artery disease: elimination of myocardial infection with Chlamydia).
Chlamydia pneumoniae, a common cause of respiratory infection, is vasotropic and frequently found in human atheromas. Whether it plays a causal role in coronary artery disease (CAD) is uncertain. The effects of 3 months of azithromycin treatment or placebo were tested in 302 patients with chronic CAD seropositive to C. pneumoniae at 3-6 months. Azithromycin reduced a global rank sum score of 4 inflammatory markers (C-reactive protein [CRP], interleukin [IL]-1, IL-6, tumor necrosis factor-alpha; P=.011) and a global rank sum change score (+/-SD) (from 535+/-201 to 587+/-190; P=.027) at 6 (but not 3) months. Change scores for CRP and IL-6 and median IL-1 levels were lower. C. pneumoniae IgG and IgA antibody titers were unchanged. Clinical cardiovascular events at 6 months did not differ between groups (azithromycin, 9; placebo, 7). Infections were reduced and drug was well tolerated. Thus, azithromycin caused modest but significant reductions in markers of inflammation, but differences in clinical events were not evident at 6 months. However, power was limited and conclusions should await results of the 2-year evaluation and larger studies.
Anderson
J L
JL
University of Utah School of Medicine, Division of Cardiology, Salt Lake City, UT 84132, USA.
Muhlestein
J B
JB
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000907:Antibodies, Bacterial / Q000097:blood; D017963:Azithromycin / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D002690:Chlamydia Infections / Q000150:complications / Q000188:drug therapy*; D016993:Chlamydophila pneumoniae / Q000276:immunology; D003327:Coronary Disease / Q000188:drug therapy* / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D007375:Interleukin-1; D015850:Interleukin-6; D017963:Azithromycin; D002097:C-Reactive Protein