To The Editor: Dr O'Connor and colleagues1 reported that a 3-month course of azithromycin did not significantly reduce the clinical sequelae of coronary heart disease (CHD) among stable patients with previous myocardial infarction and evidence of Chlamydia pneumoniae exposure. Exposure to this pathogen is, in fact, highly prevalent in the population (more than 80% of people older than 65 years may have the antibody).2
The authors' results are not entirely surprising. A likely explanation for an association between infection and CHD is through chronic inflammation. Epidemiologic studies2 - 4 have documented an independent association between the inflammatory marker C-reactive protein (CRP) and CHD, leading to a consensus document stressing the likely importance of chronic inflammation in CHD. 5 Unfortunately, the presence of IgG antibody to C pneumoniae, the criterion for entry into the study of O'Connor et al, does not confirm an ongoing chronic infection. It is likely that some of these patients had received adequate antibiotic therapy in the past (perhaps for some other indication) or that they had spontaneously cleared their infections. An alternative approach would be to study only patients with both the C pneumoniae IgG antibody and high CRP levels (suggesting a chronic infection) and measure the relationship between the effectiveness of antibiotic therapy both in changing CRP levels and recurrent clinical CHD events. This approach would demonstrate whether treating chronic inflammation caused by C pneumoniae would improve clinical outcomes.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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