Trials should assess whether antibiotics eliminate organism from atherosclerotic lesions

Editor—Gupta and Camm put the case for Chlamydia pneumoniae being involved in atherogenesis and outline possible mechanisms.1 As they point out, it is nearly 10 years since C pneumoniae was linked serologically with coronary heart disease. Interest might have waned but for Shor's observation, which was followed by international collaboration.2 Shor was the first to suspect the existence of C pneumoniae in the wall of atheromatous coronary arteries. Although some have disagreed,3 the cumulative observations of other workers leave no doubt that C pneumoniae often occurs in atheromatous coronary and other large arteries, sometimes in a viable form,4 and significantly less often in normal vessels.

As Gupta and Camm indicate, however, whether C pneumoniae initiates disease or invades after atherosclerosis has begun is unknown. If the latter, then whether it behaves as a bystander or potentiates chronic disease is also unknown. The possibility of a primary role might be looked at best by studies of early lesions in young people and by observations in animal models. Since C pneumoniae is sensitive to several antibiotics, the desire to set up extensive placebo controlled trials to help to determine …