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In Reply: We agree with Dr Nieto that clinical trials of antibiotic therapy in CHD are not designed to directly test the "infectious hypothesis" and, therefore, can neither fully establish nor rule out the role of infection in the initiation or progression of atherosclerosis. We also agree that a large body of evidence favors a role of infection and strongly supports the idea that further research and more funding are needed to clarify this issue.

One way to demonstrate the role of an infectious agent in a disease (in addition to fulfilling Koch's postulates) is to show effective prevention and/or cure of that disease with appropriate antimicrobial therapy. In this sense, an antibiotic trial with positive results would support the infectious hypothesis of atherogenesis. Whether antiinflammatory effects of antibiotics (described for macrolides but not for ampicillin or gatifloxacin) and prevention of concurrent infection (of as yet uncertain role in triggering . . . [Full Text of this Article]

Sorin Pislaru, MD, PhD
Department of Cardiology
Mayo Clinic and Foundation
Rochester, Minn

Frans Van de Werf, MD, PhD
Department of Cardiology
Gasthuisberg University Hospital and University of Leuven
Leuven, Belgium

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