Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. e675-e681 (doi:10.1542/peds.2008-0220)
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ARTICLE

Arterial Intima-Media Thickness in 13-Year-Old Adolescents and Previous Antichlamydial Antimicrobial Use: A Retrospective Follow-up Study

Iina Volanen, MD, PhDa,b, Katariina Kallio, MDa,c, Maiju Saarinen, BSSca, Mikko J. Järvisalo, MD, PhDa,d, Raija Vainionpää, PhDe, Tapani Rönnemaa, MD, PhDd, Jorma Viikari, MD, PhDd, Jukka Marniemi, PhDf, Olli Simell, MD, PhDc and Olli T. Raitakari, MD, PhDa,g

a Research Centre of Applied and Preventive Cardiovascular Medicine
b Departments of Pharmacology, Drug Development and Therapeutics
c Pediatrics
d Medicine
e Virology
g Clinical Physiology, University of Turku, Turku, Finland
f Department of Health and Functional Capacity, National Public Health Institute, Turku, Finland

BACKGROUND. Children with persistent Chlamydia pneumoniae infection may be at increased risk for atherosclerosis. The impact of antimicrobial therapy for primary prevention of atherosclerotic cardiovascular disease is unsolved.

OBJECTIVE. The purpose of this study was to determine whether treatment with antimicrobial agents effective against C pneumoniae during childhood, regardless of indication, has a favorable influence on the arterial wall-thickness in children by the time they reach adolescence.

SUBJECTS AND METHODS. The association of macrolide, tetracycline, quinolone, and rifamycin use (number of exposure events) between ages 5 and 13 years with carotid and aortic intima-media thickness at age 13 years was investigated among 508 healthy children. Information about the use of medications was obtained from the Finnish prescription register. Arterial intima-media thickness was measured with a high-resolution ultrasound.

RESULTS. Mean aortic intima-media thickness showed a significant direct association with the number of antichlamydial antimicrobial exposure events also after controlling for established atherosclerotic risk factors. Elevated C-reactive protein level had an additional effect on aortic intima-media thickness in a multivariable model. Carotid intima-media thickness was not associated with the number of preceding antichlamydial treatments.

CONCLUSIONS. Recurrent antichlamydial treatments in childhood have no favorable influence on early vascular changes but are associated with increased intima-media thickness in the abdominal aorta. These findings suggest that the use of antimicrobial agents does not offer protection against the potential atherogenicity of repeated infectious insults.

Key Words: antimicrobial agents • atherosclerosis • infection • prevention • ultrasound

Abbreviations: CAD—coronary artery disease • IMT—intima-media thickness • aIMT—aortic intima-media thickness • cIMT—carotid intima-media thickness • STRIP—Special Turku Coronary Risk Factor Intervention Project • Ig—immunoglobulin • HDL—high-density lipoprotein • LDL—low-density lipoprotein • CRP—C-reactive protein • CI—confidence interval

Accepted May 5, 2008.


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