http://bmj.com/cgi/content/full/325/7362/460/d
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 Collections under
which this article appears: Drugs:
cardiovascular system Heart
Failure |
Janice Hopkins Tanne New York
Antibiotic treatment improves outcomes in patients with acute coronary syndrome, a British study team reports.
The team’s 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 study—the South Thames trial of antibiotics in myocardial infarction and unstable angina—included 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 study’s 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 O’Donnell, 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 O’Donnell 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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Collections under
which this article appears:Drugs:
cardiovascular system Heart
Failure |
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