The Role of Macrolide Antibiotics in Increasing Cardiovascular Risk

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:66

Article

Cheng, Yun-Jiu¹  Nie, Xiao-Ying²  Chen, Xu-Miao¹  Lin, Xiao-Xiong¹  Tang, Kai¹  Zeng, Wu-Tao¹  Mei, Wei-Yi¹  Liu, Li-Juan¹  Long, Ming¹  Yao, Feng-Juan¹  Liu, Jun¹  Liao, Xin-Xue¹  Du, Zhi-Min¹  Dong, Yu-Gang¹  Ma, Hong¹  Xiao, Hai-Peng³  Wu, Su-Hua¹ 

[1] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Cardiol, Guangzhou 510080, Guangdong, Peoples R China

[2] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Outpatients, Guangzhou 510080, Guangdong, Peoples R China

[3] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Endocrinol, Guangzhou 510080, Guangdong, Peoples R China

关键词: coronary heart disease;    roxithromycin;    sudden cardiac death;    ventricular tachyarrhythmia;   

DOI  :  10.1016/j.jacc.2015.09.029

来源: Elsevier

【 摘 要 】

BACKGROUND Large cohort studies provide conflicting evidence regarding the potential for oral macrolide antibiotics to increase the risk of serious cardiac events. OBJECTIVES This study performed a meta-analysis to examine the link between macrolides and risk of sudden cardiac death (SCD) or ventricular tachyarrhythmias (VTA), cardiovascular death, and death from any cause. METHODS We performed a search of published reports by using MEDLINE (January 1, 1966, to April 30, 2015) and EMBASE (January 1, 1980, to April 30, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. RESULTS Thirty-three studies involving 20,779,963 participants were identified. Patients taking macrolides, compared with those who took no macrolides, experienced an increased risk of developing SCD or VTA (RR: 2.42; 95% CI: 1.61 to 3.63), SCD (RR: 2.52; 95% CI: 1.91 to 3.31), and cardiovascular death (RR: 1.31; 95% CI: 1.06 to 1.62). No association was found between macrolides use and all-cause death or any cardiovascular events. The RRs associated with SCD or VTA were 3.40 for azithromycin, 2.16 for clarithromycin, and 3.61 for erythromycin, respectively. RRs for cardiovascular death were 1.54 for azithromycin and 1.48 for clarithromycin. No association was noted between roxithromycin and adverse cardiac outcomes. Treatment with macrolides is associated with an absolute risk increase of 118.1 additional SCDs or VTA, and 38.2 additional cardiovascular deaths per 1 million treatment courses. CONCLUSIONS Administration of macrolide antibiotics is associated with increased risk for SCD or VTA and cardiovascular death but not increased all-cause mortality. (C) 2015 by the American College of Cardiology Foundation.

【 授权许可】

Free