Antibiotic therapy for coronary heart disease: the myth and the reality.

Atherosclerosis is acknowledged as an active inflammatory and thrombotic disease, as opposed to simple degeneration. Infection with microorganisms may contribute to this inflammation and hence the atherosclerotic process. The "infective" hypothesis - first proposed more than a century ago by Virchow - has been revisited in recent years and has implicated numerous microorganisms as potential stimuli. The greatest body of evidence points to Chlamydia pneumoniae, a respiratory pathogen, as the "culprit" microorganism. Consistent finding of bacterial antigens, DNA and occasionally live "viable" organisms within human atherosclerotic plaque support the evidence for the concept linking C. pneumoniae to atherosclerosis. Although original seroepidemiological studies indicated an association, more recent prospective and larger studies suggest that there may be only a weak link between elevated antibodies and immune complexes to C. pneumoniae and coronary heart disease (CHD). Animal models have shown how atherogenesis can be induced by endovascular infection with C. pneumoniae; in vitro studies have explored various immunological and inflammatory pathways linking infection and atherothrombosis. On the basis of this, antibiotic trials have been explored to assess whether there is any role for antichlamydial agents in the treatment of cardiovascular events. Here, we focus on the main antibiotic studies and explores patient criteria and choice, duration of therapy, and whether effects on clinical events could be reduced.

Antibiotic therapy for coronary heart disease: The myth and the reality.

Atherosclerosis is acknowledged as an active inflammatory and thrombotic disease, as opposed to simple degeneration. Infection with microorganisms may contribute to this inflammation and hence the atherosclerotic process. The "infective" hypothesis--first proposed more than a century ago by Virchow--has been revisited in recent years and has implicated numerous microorganisms as potential stimuli. The greatest body of evidence points to Chlamydia pneumoniae, a respiratory pathogen, as the "culprit" microorganism. Consistent finding of bacterial antigens, DNA and occasionally live "viable" organisms within human atherosclerotic plaque support the evidence for the concept linking C. pneumoniae to atherosclerosis. Although original seroepidemiological studies indicated an association, more recent prospective and larger studies suggest that there may be only a weak link between elevated antibodies and immune complexes to C. pneumoniae and coronary heart disease (CHD). Animal models have shown how atherogenesis can be induced by endovascular infection with C. pneumoniae; in vitro studies have explored various immunological and inflammatory pathways linking infection and atherothrombosis. On the basis of this, antibiotic trials have been explored to assess whether there is any role for antichlamydial agents in the treatment of cardiovascular events. Here, we focus on the main antibiotic studies and explores patient criteria and choice, duration of therapy, and whether effects on clinical events could be reduced.

Electronic clinical trial protocol distribution via the World-Wide Web: a prototype for reducing costs and errors, improving accrual, and saving trees.

Clinical trials today typically are inefficient, paper-based operations. Poor community physician awareness of available trials and difficult referral mechanisms also contribute to poor accrual. The Physicians Research Network (PRN) web was developed for more efficient trial protocol distribution and eligibility inquiries. The Medical University of South Carolina's Hollings Cancer Center trials program and two community oncology practices served as a testbed. In 581 man-hours over 18 months, 147 protocols were loaded into PRN. The trials program eliminated all protocol hardcopies except the masters, reduced photocopier use 59%, and saved 1.0 full-time equivalents (FTE), but 1.0 FTE was needed to manage PRN. There were no known security breaches, downtime, or content-related problems. Therefore, PRN is a paperless, user-preferred, reliable, secure method for distributing protocols and reducing distribution errors and delays because only a single copy of each protocol is maintained. Furthermore, PRN is being extended to serve other aspects of trial operations.