Azithromycin for the Secondary Prevention of Coronary Events

Grayston, J. T.; Kronmal, Richard A.; Jackson, Lisa A.; Parisi, Alfred F.; Muhlestein, Joseph B.; Cohen, Jerome D.; Rogers, William J.; Crouse, John R.; Borrowdale, Sandra L.; Schron, Eleanor B.; Knirsch, Charles

doi:10.1056/nejmoa043526

Cited by 335 publications

(180 citation statements)

References 25 publications

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“…Although other evidence implicates infections and the immune system in cardiovascular disease [19,35,36], the negative findings of two randomized-controlled trials of antibiotic administration [37,38] suggest that bacterial infection is not likely involved in circulatory disease. The somewhat high (albeit nonsignificant) risks for hypertensive heart disease and CeVD if RBM dose is used (Table 6) (weakly) suggest that dose to this tissue may not be relevant for these endpoints.…”

Section: Discussionmentioning

confidence: 99%

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

et al. 2015

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High-dose ionizing radiation is associated with circulatory disease. Risks from lower-dose fractionated exposures, such as from diagnostic radiation procedures, remain unclear. In this study we aimed to ascertain the relationship between fractionated low-to-medium dose radiation exposure and circulatory disease mortality in a cohort of 13,568 tuberculosis patients in Massachusetts, some with fluoroscopy screenings, between 1916 and 1961 and follow-up until the end of 2002. Analysis of mortality was in relation to cumulative thyroid (cerebrovascular) or lung (all other circulatory disease) radiation dose via Poisson regression. Over the full dose range, there was no overall radiation-related excess risk of death from circulatory disease (n = 3221; excess relative risk/Gy -0.023; 95 % CI -0.067, 0.028; p = 0.3574). Risk was somewhat elevated in hypertensive heart disease (n = 89; excess relative risk/Gy 0.357; 95 % CI -0.043, 1.030, p = 0.0907) and slightly decreased in ischemic heart dis-ease (n = 1950; excess relative risk/Gy -0.077; 95 % CI -0.130, -0.012; p = 0.0211). However, under 0.5 Gy, there was a borderline significant increasing trend for all circulatory disease (excess relative risk/Gy 0.345; 95 % CI -0.032, 0.764; p = 0.0743) and for ischemic heart disease (excess relative risk/Gy 0.465; 95 % CI, -0.032, 1.034, p = 0.0682). Pneumolobectomy increased radiation-associated risk (excess relative risk/Gy 0.252; 95 % CI 0.024, 0.579). Fractionation of dose did not modify excess risk. In summary, we found no evidence of radiation-associated excess circulatory death risk overall, but there are indications of excess circulatory death risk at lower doses (<0.5 Gy). Although consistent with other radiation-exposed groups, the indications of higher risk at lower doses are unusual and should be confirmed against other data.

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Section: Discussionmentioning

confidence: 99%

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

et al. 2015

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“…11 Trials of antibiotics, however, have not shown benefit in lowering the risk of recurrent coronary events. 12,13 Similarly, treatments aimed at eliminating or controlling chronic infections have not proven to be helpful for the prevention of stroke. 10 Inflammatory biomarkers such as high-sensitivity C-reactive protein and lipoproteinassociated phospholipase A2 are also independently associated with cardiovascular and stroke risk.…”

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confidence: 99%

Left atrial enlargement: A cause of stroke?

Goldstein¹

2011

Canadian Medical Association Journal

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A lthough there are a variety of established risk factors for ischemic stroke and its common pathophysiologies are well known, a specific cause remains undefined in 25%-40% of instances. That rate is influenced in part by the thoroughness of the poststroke evaluation.1 A cause, however, can remain undetermined in up to 12% of patients having an acute event, even with a full diagnostic assessment. 2At least part of the diagnostic uncertainty can be related to the impact of relatively unrecognized risk factors. For example, the most widely used stroke risk assessment tool, the Framingham stroke risk profile, includes the following wellrecognized stroke risk factors: age, systolic blood pressure, use of antihypertensive medications, diabetes mellitus, smoking, having cardiovascular disease, atrial fibrillation and left ventricular hypertrophy on electrocardiography.3 Although this tool is useful, many people have strokes despite a low Framingham stroke risk profile score, which does not incorporate a variety of less established risk factors. In this week's CMAJ, Bouzas-Mosquera and colleagues 4 describe an independent, graded association between left atrial size on electrocardiography and stroke risk in women but not in men. Prior studies reported a similar relation between left atrial size and ischemic stroke risk in men, but not in women. 5,6 The reason for the discrepancy among these studies is uncertain, and the findings need to be validated through replication in other patient populations. Bouzas-Mosquera and coauthors posit that the variability among reports might be a result of differences in study populations. Another possibility is that left atrial enlargement is a risk marker that only indirectly reflects one or a combination of risk factors. For example, left atrial enlargement is associated with an increased risk of atrial fibrillation, 7 which is a major stroke risk factor that may become apparent only with prolonged and repeated cardiac monitoring.Left atrial enlargement also might be a marker for other conditions that could increase stroke risk. For example, left atrial dysfunction can occur in patients with a patent foramen ovale. Patent foramen ovale (not assessed in the study by Bouzas-Mosquera and colleagues) is found more commonly in patients with cryptogenic stroke than in those with no history of stroke or in those who have stroke of determined cause. 9Paradoxical embolism through a patent foramen ovale may be important in the pathophysiology of acute stroke in patients with deep vein thrombosis, a relatively rare event.The role of patent foramen ovale in patients without a source of embolism is less certain. There is no difference in the rate of recurrent stroke between groups of patients with otherwise cryptogenic stroke who do or do not have a patent foramen ovale, regardless of the type of medical treatment (antiplatelet medication v. anticoagulation). One randomized trial with results reported in abstract form (CLOSURE-1, 2011 International Stroke Conference) found no difference in the ...

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“…WIZARD (Weekly Intervention with Zithromax for Atherosclerosis and Related Disorder) study 24 failed to find a long term benefit of administering Azithromycin for individuals with stable coronary artery disease, serologic evidence of C. Pneumoniae and past history of myocardial infarction. The ineffectiveness of antibiotics for prevention of secondary cardiovascular events has also been shown in ACES, 25 PROVE IT-TIMI 26 and AZACS 27 trials. But STAMINA 28 trial found that antibiotic treatment significantly reduces adverse cardiac events in patients with acute coronary syndromes, but this was independent of H. pylori or C. pneumoniae seropositivity.…”

Section: Discussionmentioning

confidence: 86%

Early prognosis of unstable angina patients with positive Helicobacter pylori IgG values

Kaulgud

Kamath

2013

Int Jour of Biomed Res

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Azithromycin for the Secondary Prevention of Coronary Events

Abstract: A one-year course of weekly azithromycin did not alter the risk of cardiac events among patients with stable coronary artery disease.

Cited by 335 publications

References 25 publications

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

Left atrial enlargement: A cause of stroke?

Early prognosis of unstable angina patients with positive Helicobacter pylori IgG values

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