Five-week antibiotic treatment may improve cardiovascula...( d at the end of treatment. FMD measure...),Health

d at the end of treatment. FMD measures the blood vessels ability to relax in response to blood flow increases, and also endothelial function. A healthy artery (with a healthy endothelium) will be more flexible than a diseased artery. In addition, levels of E-selectin and von Willebrand factor (both markers of endothelial dysfunction) and levels of C-reactive protein (a marker of inflammation) were measured at entry and after treatment.

After treatment, patients average FMD of the brachial artery improved from 2.66 percent at baseline to 4.78 percent. In the placebo group the baseline measurement was 3.11 percent and at five weeks it was 3.09 percent, indicating no improvement. Moreover, in treated patients, the level of E-selectin declined by an average of 28.2 nanograms per milliliter (ng/mL) in treated patients and von Willebrand factor level declined by an average of 36.6 International Units per deciliter (IU/dL).

The study showed improved arterial function, but it was not designed to provide evidence that the antibiotic could reverse atherosclerosis or reduce the number of heart attacks. Moreover, Kaski says the benefit of the antibiotic might not be a direct result of the drugs ability to eradicate the pathogen, because their study showed that patients who had very high levels of C. pneumoniae antibodies had essentially the same benefit as those with low levels.

A direct anti-inflammatory action of the antibiotic has been suggested because azithromycin is in a class of drugs called macrolides, which have anti-inflammatory effects. Inflammation is one of the bodys responses to infection. But Kaski says that the question remains open since azithromycin did not reduce the levels of C-reactive protein in this study.

Thus whether the beneficial effects of azithromycin were due to its antibacterial or anti-inflammatory actions is unresolved by our study, says Kaski.

The next step, he says, is to design a study that will allow the
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
25-Feb-2002

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