Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: We agree with Dr Nieto that clinical
trials of antibiotic therapy in CHD are not designed to directly test the
"infectious hypothesis" and, therefore, can neither fully establish nor rule
out the role of infection in the initiation or progression of atherosclerosis.
We also agree that a large body of evidence favors a role of infection and
strongly supports the idea that further research and more funding are needed
to clarify this issue.
One way to demonstrate the role of an infectious agent in a disease
(in addition to fulfilling Koch's postulates) is to show effective prevention
and/or cure of that disease with appropriate antimicrobial therapy. In this
sense, an antibiotic trial with positive results would support the infectious
hypothesis of atherogenesis. Whether antiinflammatory effects of antibiotics
(described for macrolides but not for ampicillin or gatifloxacin) and prevention
of concurrent infection (of as yet uncertain role in triggering acute coronary
events) do also play a role is at this time unknown.
Pislaru S, Van de Werf F. Antibiotics and Coronary Heart Disease—Reply. JAMA. 2004;291(3):302. doi:10.1001/jama.291.3.303-b