Emerging role of antibiotics in atherosclerosis,

It has been shown that plaque composition changes significantly in the setting of acute events, macrophages and T cells being the predominant pattern at the immediate site of fissure or erosion. There appears to be a relation between physical blood stream factors, plaque morphology, and the distribution of inflammatory cells. Furthermore, there is cumulative evidence for the presence of intracellular pathogens in the arterial wall, namely Chlamydia pneumoniae and cytomegalovirus, which affect endothelial cells, monocytes, and macrophages. The ROXIS trial has shown some encouraging evidences for the potential role of intracellular pathogens in acute coronary syndromes. The ongoing WIZARD trial evaluates in a large population whether the addition of an antibiotic provides better outcome for coronary patients. (Am Heart J 1999;138:S537-S538.)