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.
The Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark. j.hilden@biostat.ku.dk
Jørgen
J
Hilden
Inga
I
Lind
Hans Jørn
HJ
Kolmos
Bodil
B
Als-Nielsen
Morten
M
Damgaard
Jørgen Fischer
JF
Hansen
Stig
S
Hansen
Olav H
OH
Helø
Per
P
Hildebrandt
Gorm Boje
GB
Jensen
Jens
J
Kastrup
Erik
E
Kjøller
Henrik
H
Nielsen
Lars
L
Petersen
Christian M
CM
Jespersen
Christian
C
Gluud
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