Azithromycin ineffective for secondary coronary heart disease prevention

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Q&A

Azithromycin ineffective for secondary coronary heart disease prevention

J Fam Pract. 2004 January;53(1):8-24

By

Andrea D. Tribastone, MD

BACKGROUND: Several studies have found an association between infection with C pneumoniae and atherogenesis. Unfortunately, results from smaller studies as to whether antibiotics are helpful in preventing CHD events have been mixed. The objective of the Weekly Intervention with Zithromax for Atherosclerosis and Related Disorders (WIZARD) study was to determine if 3 months of treatment with azithromycin had an effect on recurrent CHD events in a large population of stable patients who have been exposed to C pneumoniae.
POPULATION STUDIED: The investigators studied 7747 adult outpatients with a history of myocardial infarction more than 6 weeks before screening (documented by electrocardiogram or elevation of creatinine kinase) and an immunoglobulin G titer to C pneumoniae of 1:16 or greater. Patients were excluded if they had undergone coronary artery bypass graft surgery or percutaneous coronary intervention in the preceding 6 months, required chronic antibiotic therapy, or had received antibiotics in the previous 3 months. Patients were enrolled from the United States, Canada, United Kingdom, Germany, France, Spain, Austria, India, and Argentina.
STUDY DESIGN AND VALIDITY: In this double-blind study, participants were randomly assigned to receive either azithromycin 600 mg or placebo daily for 3 days, then weekly for the next 11 weeks. Randomization was performed by blinded medication blocks, which contained an equal number of each treatment assignment. Sealed envelopes containing the treatment assignment were also provided to each site, to be opened only in case of emergency. Study participants were seen in clinic for blood samples (red blood cell indices, creatinine, and liver function) or contacted by phone at 6-week to 4-month intervals. Investigators who were blinded to treatment assignment assessed outcomes based on predefined criteria for primary and secondary endpoints.
OUTCOMES MEASURED: The investigators defined a primary event as the first occurrence of death by any cause, recurrent myocardial infarction, coronary revascularization procedure (coronary artery bypass graft surgery or percutaneous coronary intervention), or hospitalization for angina. Secondary outcomes included a noncoronary atherosclerotic event (stroke, transient ischemic attack, or intervention for peripheral vascular disease, whichever occurred first), cardiovascular death, and hospitalization for congestive heart failure.
RESULTS: Treatment with azithromycin was associated with no significant reduction in the risk of developing any of the primary endpoints studied, including all cause death, myocardial infarction, coronary revascularization procedure or hospitalization for angina (relative risk=7%; 95% confidence interval, –5% to 17%; P=.23). Secondary outcomes were also unaffected by treatment with azithromycin.

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Azithromycin ineffective for secondary coronary heart disease prevention

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