Rationale and design of a secondary prevention trial of antibiotic use in patients after myocardial infarction: The WIZARD (weekly intervention with zithromax [azithromycin] for atherosclerosis and its related disorders) trial

Mounting evidence supports the contention that atherosclerosis is an inflam matory disease. Recently a possible role far infectious microorganisms has gathered attention. Chlamydia pneumoniae is one possible pathogen. If C. pn eumoniae is a target organism, antibiotics with antichlamydial activity may be able to ameliorate plaque instability. The WIZARD trial is a secondary prevention study that is assessing the impact of a 3-month course of azithr omycin compared with placebo on the progression of clinical coronary heart disease. The study will enroll 3300 patients who have had a prior myocardia l infarction and who have a C. pneumoniae IgG titer of greater than or equa l to 1:16. The primary end point is a composite of time to either recurrent myocardial infarction, death, a revascularization procedure, or hospitaliz ation for angina. This study is the first of a series of adequately powered clinical trials that will attempt to bridge insights from preclinical inve stigations to interventions applicable to patient care.