Effect of 3 Months of Antimicrobial Treatment With Clarithromycin in Acute Non–Q-Wave Coronary Syndrome

Abstract

Background-Coronary artery disease, an inflammatory disease, may be caused by infection. We investigated whether the antibiotic clarithromycin would reduce morbidity and mortality in patients with acute non-Q-wave coronary syndrome. Methods and Results-Altogether, 148 patients with acute non-Q-wave infarction or unstable angina were randomly assigned to receive double-blind treatment with either clarithromycin or placebo for 3 months. The primary end point was a composite of death, myocardial infarction, or unstable angina during treatment; the secondary end point was occurrence of any cardiovascular event during the entire follow-up period (average 555 days, range 138 to 924 days).There was a trend toward fewer patients meeting primary end-point criteria in the clarithromycin group than in the placebo group (11 versus 19 patients, respectively; risk ratio 0.54, 95% CI 0.25 to 1.14; Pϭ0.10). By the end of the entire follow-up, 16 patients in the clarithromycin group and 27 in the placebo group had experienced a cardiovascular event (risk ratio 0.49, 95% CI 0.26 to 0.92; Pϭ0.03). Conclusions-Clarithromycin appears to reduce the risk of ischemic cardiovascular events in patients presenting with acute non-Q-wave infarction or unstable angina. No signs of this effect diminishing were observed during follow-up.

A meta-analysis of antibiotic use for the secondary prevention of cardiovascular diseases

“…Trial populations were slightly variable. Six trials were conducted among patients with stable coronary artery disease (10,(13)(14)(15)(16)(17) and six trials involved patients with acute coronary syndromes (18)(19)(20)(21)(22)(23). The remaining trial was conducted among patients scheduled to undergo coronary artery bypass graft surgery (24).…”

Reduced Progression of Early Carotid Atherosclerosis After Antibiotic Treatment and Chlamydia pneumoniae Seropositivity

“…Interestingly, the recently published CLARIFY trial observed a reduction of the risk of ischemic cardiovascular events in patients presenting with acute non-Q-wave infarction or unstable angina attributable to clarithromycin treatment for 3 months. 10 B-mode ultrasonography provides the opportunity to relate risk factors to atherosclerosis in patients with early lesions. Ultrasonographically determined increased IMT of the CCA was identified as a strong predictor of stroke and myocardial infarction.…”

“…The evidence for Cp as a potential causative agent is strong and is based on findings of seroepidemiological studies, 5 in vitro animal models, 6 and pilot antichlamydial antibiotic intervention trials. [7][8][9][10][11][12] However, other clinical, 13,14 experimental, 15 and histopathological examinations 16 questioned the causal role of Cp for the development of atherosclerosis. Based on these different results, some investigators 14 hypothesize that the detection of a positive effect of antibiotic therapy on clinical end points may need even larger patient numbers or longer follow-up periods and that it therefore seems reasonable to analyze the impact of antibiotic therapy on surrogate parameters of atherosclerosis formation.…”

Effect of Treatment for Chlamydia pneumoniae and Helicobacter pylori on Markers of Inflammation and Cardiac Events in Patients With Acute Coronary Syndromes

“…This possibility is supported not only by the present study and the ROXIS study 9 but also by a recently published trial of clarithromycin in acute non-Q-wave coronary syndromes. 16 The design of the present study was pragmatic in ascertaining antibiotic efficacy but does not allow the drawing of conclusions as to the mechanism of action of these agents. The antibiotic regimens were chosen to represent a standard H pylori eradication course and a C pneumoniae treatment regimen.…”