Antibiotics can improve outcomes in heart patients
Janice Hopkins Tanne New York
Antibiotic treatment improves outcomes in patients with acute coronary
syndrome, a British study team reports.
The teams report, to be published in Circulation (but already
available at www.circulationaha.org), says that antibiotic treatment improves
outcomes in patients with acute coronary syndrome, even if they do not have
signs of infection with Helicobacter pylori or Chlamydia pneumoniae.
Meanwhile, in a separate but related study to be published in the same issue,
researchers from the Framingham heart study in Massachusetts report that
concentrations of C reactive protein seem to predict calcification and
subclinical atherosclerosis in apparently healthy men and women.
The British studythe South Thames trial of antibiotics in myocardial
infarction and unstable anginaincluded 325 patients with acute coronary
syndromes. About half the patients tested positive for H pylori and about
40% for C pneumoniae. One group was given placebo, a second group
received amoxicillin, metronidazole, and omeprazole, and a third group had
azithromycin, metronidazole, and omeprazole. The amoxicillin regimen is
effective against H pylori, and the azithromycin regimen works against
C pneumoniae.
The surprising finding was that all patients treated with antibiotics did
better on clinical end points of cardiac death or readmission with acute
coronary syndrome up to one year later, whether or not they had H pylori
or C pneumoniae. The authors speculate that antibiotic treatment may
stabilise atherosclerotic plaques and that macrolide antibiotics have
anti-inflammatory activity.
The Framingham study measured concentrations of C reactive protein, which is
produced mostly by the liver and indicates inflammation, at one of the studys
examinations of patients, which occur about every four years. The study included
327 people (mean age 60). "These were healthy, free-living individuals largely
free of antibiotic use. They had no clinical evidence of infection," said Dr
Christopher ODonnell, the principal investigator.
On the basis of their C reactive protein concentrations, patients were
divided into low, medium, and high risk groups. From four to eight years later
they underwent electron beam computed tomography to assess coronary artery
calcification. For each patient the researchers calculated a weighted
calcification score, which is based on the density of coronary calcium and
correlates with the number of coronary plaques. Patients with higher
concentrations of C reactive protein in the earlier test had higher
calcification scores, indicating that they were at higher risk for
cardiovascular events.
Dr ODonnell says it is too early to suggest routine use of both tests. The
cost in the United States would probably be $450 (£296; 464) to $600 per
patient.
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