Chlamydia pneumoniae IgG and IgA antibody titers and prognosis in patients with coronary heart disease: results from the CLARICOR trial.
The association observed between coronary heart disease (CHD) and Chlamydia (Chlamydophila) pneumoniae antibodies prompted, during the 1990s, several primary and secondary prevention trials with various antibiotics. In our CLARICOR trial, a randomized placebo-controlled trial in 4372 patients with stable CHD, a brief clarithromycin regimen was followed, unexpectedly, by increased long-term mortality. We now compare C. pneumoniae antibody levels at entry with population levels, with the patients' individual histories, and with their subsequent outcomes. IgG antibody levels were somewhat raised, but elevated IgA and IgG titers were unrelated to entry data (including prior acute myocardial infarction), except for an association with smoking and with not using statins. Hazards of mortality and of other outcomes tended to slightly increase with IgA and decrease with IgG titers, but the unfavorable clarithromycin effect was unrelated to antibody levels and remains unexplained. Smoking-related lung disease probably underlies the link between heart disease and increased IgG titers.
Hilden
Jørgen
J
The Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark. j.hilden@biostat.ku.dk
Lind
Inga
I
Kolmos
Hans Jørn
HJ
Als-Nielsen
Bodil
B
Damgaard
Morten
M
Hansen
Jørgen Fischer
JF
Hansen
Stig
S
Helø
Olav H
OH
Hildebrandt
Per
P
Jensen
Gorm Boje
GB
Kastrup
Jens
J
Kjøller
Erik
E
Nielsen
Henrik
H
Petersen
Lars
L
Jespersen
Christian M
CM
Gluud
Christian
C
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood*; D023521:Chlamydophila Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D016993:Chlamydophila pneumoniae / Q000187:drug effects / Q000276:immunology*; D017291:Clarithromycin / Q000627:therapeutic use; D003327:Coronary Disease / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010919:Placebos / Q000008:administration & dosage; D011379:Prognosis; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D010919:Placebos; D017291:Clarithromycin