Azithromycin for the Secondary Prevention of Coronary Events
J. Thomas Grayston, M.D., Richard A. Kronmal, Ph.D., Lisa A. Jackson, M.D., Alfred F. Parisi, M.D., Joseph B. Muhlestein, M.D., Jerome D. Cohen, M.D., William J. Rogers, M.D., John R. Crouse, M.D., Sandra L. Borrowdale, M.S., Eleanor Schron, M.S., Charles Knirsch, M.D., for the ACES Investigators
Background Epidemiologic, laboratory, animal, and clinical studiessuggest that there is an association between Chlamydia pneumoniaeinfection and atherogenesis. We evaluated the efficacy of oneyear of azithromycin treatment for the secondary preventionof coronary events.
Methods In this randomized, prospective trial, we assigned 4012patients with documented stable coronary artery disease to receiveeither 600 mg of azithromycin or placebo weekly for one year.The participants were followed for a mean of 3.9 years at 28clinical centers throughout the United States.
Results The primary end point, a composite of death due to coronaryheart disease, nonfatal myocardial infarction, coronary revascularization,or hospitalization for unstable angina, occurred in 446 of theparticipants who had been randomly assigned to receive azithromycinand 449 of those who had been randomly assigned to receive placebo.There was no significant risk reduction in the azithromycingroup as compared with the placebo group with regard to theprimary end point (risk reduction, 1 percent [95 percent confidenceinterval, –13 to 13 percent]). There were also no significantrisk reductions with regard to any of the components of theprimary end point, death from any cause, or stroke. The resultsdid not differ when the participants were stratified accordingto sex, age, smoking status, presence or absence of diabetesmellitus, or C. pneumoniae serologic status at baseline.
Conclusions A one-year course of weekly azithromycin did notalter the risk of cardiac events among patients with stablecoronary artery disease.
Source Information
From the Departments of Epidemiology (J.T.G., L.A.J.) and Biostatistics (R.A.K.), University of Washington, Seattle; the Center for Health Studies, Group Health Cooperative, Seattle (L.A.J.); Miriam Hospital, Providence, R.I. (A.F.P.); LDS Hospital, Salt Lake City (J.B.M.); Saint Louis University Medical Center, St. Louis (J.D.C.); University of Alabama, Birmingham (W.J.R.); Wake Forest University School of Medicine, Winston-Salem, N.C. (J.R.C.); Axio Research, Seattle (S.L.B.); National Heart, Lung, and Blood Institute, Bethesda, Md. (E.S.); and Pfizer, New York (C.K.).
Address reprint requests to Dr. Grayston at the Department of Epidemiology, Box 357236, University of Washington, Seattle, WA 98195.
Chlamydia pneumoniae and Acute Coronary Syndrome
Wong B. Y.L., Gnarpe J., Mitchell W. M., Stratton C. W., Frothingham R., Paul M., Fraser A., Leibovici L., Grayston J. T., Cannon C. P., the ACES Investigators , the PROVE IT–TIMI 22 Investigators
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N Engl J Med 2005;
353:525-528, Aug 4, 2005.
Correspondence
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