HIGHLIGHTS: A clinical trial currently under way at Cedars-Sinai Medical Center could have profound ramifications for preventing recurring heart attacks by using a common, inexpensive antibiotic. AVAILABLE FOR INTERVIEWS: Bojan Cercek, M.D., Ph.D., Director, Coronary Care Unit, Cedars-Sinai Medical Center P.K.Shah, M.D., Chairman, Division of Cardiology, Cedars-Sinai Medical Center; Professor of Medicine, UCLA School of Medicine. LOS ANGELES (November 12, 1998) - A common, inexpensive antibiotic could reduce a second heart attack in patients who have already suffered an acute heart attack. In a clinical trial involving 1,400 patients, Cedars-Sinai Medical Center scientists, as well as collaborators at two facilities in Israel and three in Europe, are testing the effectiveness of the common antibiotic, Azithromycin, in preventing recurrent heart attacks.
"Of people who have just had a heart attack, 20 to 25 percent are likely to have another heart attack within the next six months," says Bojan Cercek, M.D., Ph.D., Lead Investigator and Director of the Coronary Care Unit at Cedars-Sinai.
"There is a growing body of scientific evidence implicating ongoing inflammation (accumulation of white blood cells) in plaque formation and plaque disruption that leads to blood clots and heart attacks, says P.K.Shah, M.D., Chairman of Cardiology at Cedars-Sinai.
According to Dr. Shah, "Cholesterol accumulation inside the plaque provides one of the stimuli for inflammation; the other may be bacterial/viral infection of the plaque. Therefore we designed the current AZACS study to determine the potential value of antibiotics for heart attack prevention."
"Chlamydia pneumonia, a common bacteria that causes respiratory infections, has been identified in 30 to 40 percent of plaques where it may stimulate the white blood cells to trigger a heart attack," says Dr. Cercek. "If this hypothesis is correct, treating the patient with the antibiotic Azithromycin for five days after the initial heart attack, could prevent the ongoing infection and ultimately prevent the second heart attack."
Patients are enrolled in the randomized clinical trial immediately after experiencing an initial heart attack, and undergo a check-up 20 days later, followed by one at six months. Half receive the antibiotic, and half receive a placebo. An initial blood test looks at the effect of the medication and compares to see if antibodies to the chlamydia are present.
"The ramifications of this study are profound," says Dr. Cercek. "Despite lowering patients' cholesterol levels and using such treatment modalities as angioplasty, we still have difficulty bringing the heart attack recurrence level to under 20 percent. If our hypothesis is correct, this safe, inexpensive and non-toxic antibiotic can play a significant role in preventing future heart attacks and represent a major step forward in the battle against heart disease."
To date, physician response and referrals to the clinical trial have been excellent, and Dr. Cercek anticipates that the target number of 1,400 patients will be reached within 12 to 18 months. Funding for this clinical trial is solely provided by the Division of Cardiology and the Stephen S. Cohen Fund. For more information, please call 310-855-3836.
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