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January 21, 2004

Antibiotics and Coronary Heart Disease—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(3):302. doi:10.1001/jama.291.3.303-a

In Reply: We agree with Drs Modest and Kaufmann that CRP might be helpful in identifying patients most likely to respond to antibiotic treatment. We are currently exploring the importance of CRP, other markers of inflammation, and additional measures of C pneumoniae infection as part of our trial.

Dr Nieto cites data to support the role of C pneumoniae in both the initiation of an atherosclerotic plaque and the progression of such plaques. We agree that a secondary prevention trial cannot define the value of an intervention in a primary prevention setting. We chose a secondary prevention trial to study the use of azithromycin mainly for logistical reasons centered on the incidence of cardiovascular events and the potentially more favorable risk-benefit assessment were the outcome to be successful.

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