Antibiotics help heart patients

one kind of pneumonia and H. pylori causes stomach ulcers.

During one year of follow-up, patients who received the antibiotics were 36 percent less likely to be rehospitalized for unstable angina or a nonfatal heart attack, or to suffer a fatal heart attack, than those who took a placebo.

"It is an interesting proposal that antibiotics can affect a condition that has always been regarded as noninfectious," says Mendall, also a senior lecturer at St. George's Medical School, Tooting, London. "The question, of course, is whether the antibiotics are working against bacteria to improve heart outcome or whether the antibiotics improve outcome by an anti-inflammatory action." Inflammation plays a major role in coronary heart disease. Recent studies suggest that biological markers of inflammation identify people at high risk of developing the disease. Moreover, an association has been shown to exist between chronic infections, inflammatory markers and coronary heart disease.

The researchers, who included both cardiologists and gastroenterologists, set out to explore two issues: First, could the antibiotics amoxycillin, metronidazole and omeprazole (active against H. pylori) and azithromycin, metronidazole and omeprazole (active against C. pneumoniae and H. pylori) reduce levels of C-reactive protein, fibrinogen, and white cells, which at elevated concentrations in the blood indicate inflammation? Second, could the antibiotic treatments reduce the risk of angina and fatal and nonfatal heart attacks?

"The difference between the two antibiotic regimens is that azithromycin is known to have an anti-inflammatory property," Mendall says. "Amoxycillin has not been reported to have an anti-inflammatory effect. Alternately, the failure to find a difference in effect between the two antibiotic regimens suggests that metronidazole or omeprazole may be the important component of the regimen."

Metronidazole is used in other

Contact: Carole Bullock
American Heart Association

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