This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr O'Connor and colleagues¹ found no benefit of azithromycin in the secondary prevention of CHD. In their accompanying Editorial, Drs Pislaru and Van de Werf² suggested that either C pneumoniae does not play a role in atherogenesis or that perhaps the proper antibiotic regimen was not used. Thus, Pislaru and Van de Werf recommend waiting for the results of ongoing trials with different antibiotic treatment regimens before embracing the first explanation.

A fundamental problem, however, is that none of these trials were designed to test the "infectious hypothesis" of atherogenesis. By definition, patients in secondary prevention trials have substantial atherosclerosis in their coronary arteries. Thus, the lack of a positive result cannot be used to rule out the hypothesis that infections might be involved in the initiation or progression of the inflammatory process in atherosclerosis, which often takes place decades before the first clinical manifestations of the . . . [Full Text of this Article]

F. Javier Nieto, MD, PhD
Department of Population Health Sciences
University of Wisconsin Medical School
Madison

RELATED ARTICLES

Antibiotics and Coronary Heart Disease
Geoffrey A. Modest and Julie Kaufmann
JAMA. 2004;291(3):302.
EXTRACT | FULL TEXT  

Antibiotics and Coronary Heart Disease—Reply
Michael W. Dunne, Rebecca J. Benner, Christopher M. O'Connor, Marc A. Pfeffer, Joseph B. Muhlestein, Louis Yao, Sandeep Gupta, Marian R. Fisher, and Thomas D. Cook
JAMA. 2004;291(3):303.
EXTRACT | FULL TEXT  

Antibiotics and Coronary Heart Disease—Reply
Sorin Pislaru and Frans Van de Werf
JAMA. 2004;291(3):303.
EXTRACT | FULL TEXT  

Azithromycin for the Secondary Prevention of Coronary Heart Disease Events: The WIZARD Study: A Randomized Controlled Trial
Christopher M. O'Connor, Michael W. Dunne, Marc A. Pfeffer, Joseph B. Muhlestein, Louis Yao, Sandeep Gupta, Rebecca J. Benner, Marian R. Fisher, and Thomas D. Cook
JAMA. 2003;290(11):1459-1466.
ABSTRACT | FULL TEXT