The Role of Macrolide Antibiotics in Increasing Cardiovascular Risk

Cheng, Yun‐Jiu; Nie, Xiao‐Ying; Chen, Xumiao; Lin, Xuemei; Tang, Kai; Zeng, Wenjing; Mei, Wei‐Yi; Liu, Lijuan; Long, Ming; Yao, Fengjuan; Liu, Jun; Liao, Xinxue; Du, Zhimin; Dong, Yugang; Ma, Hong; Xiao, Hang; Wu, Shuizhu

doi:10.1016/j.jacc.2015.09.029

Cited by 134 publications

(100 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, this mostly reflects the short-term use of CLM as an antimicrobial. In proposing its long-term use as a cachexia treatment, we consider additional caution appropriate, particularly given concerns about prolongation of the QT interval and the increased risk of ventricular arrhythmias and sudden cardiac death observed in patients receiving CLM (and other macrolides) [16]. Previous studies of CLM for cancer cachexia predate the emergence of these safety concerns [7,8].…”

Section: Discussionmentioning

confidence: 99%

Is clarithromycin a potential treatment for cachexia in people with lung cancer? A feasibility study

et al. 2017

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Is clarithromycin a potential treatment for cachexia in people with lung cancer? A feasibility study

et al. 2017

View full text Add to dashboard Cite

“…12 Heterogeneity was also calculated by comparing results from studies stratified according to prespecified study-level characteristics with meta-regression and subgroup analyses. 13 Sensitivity analysis was performed to assess the effects of selected study quality. Possible publication bias was assessed by using Begg's adjusted rank correlation test and Egger's regression asymmetry tests and by visual inspection for asymmetry of a funnel plot of the natural logarithms of the effect estimates against their standard errors.…”

Section: Methodsmentioning

confidence: 99%

Digoxin Use and Adverse Outcomes in Patients With Atrial Fibrillation

Zeng

Liu

et al. 2016

Medicine

Self Cite

View full text Add to dashboard Cite

Digoxin has long been used for rate control in atrial fibrillation (AF); its safety remains controversial.We performed a literature search using MEDLINE (source PubMed, January 1, 1966, to July 31, 2015) and EMBASE (January 1, 1980, to July 31, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Pooled effect estimates were obtained by using random-effects meta-analysis.Twenty-two studies involving 586,594 patients were identified. Patients taking digoxin, as compared with those who took no digoxin, experienced an increased risk of death from any cause (RR: 1.29[95% CI 1.16–1.43]), even after reported adjustment for propensity scores (RR: 1.28[95% CI 1.18–1.39]). The risk of death was increased with patients with or without heart failure (RR: 1.12[95% CI 1.02–1.23] and RR: 1.26[95% CI 1.15–1.29], respectively), and patients taking or not taking beta blockers (RR: 1.17 [95% CI 1.06–1.30] and RR: 1.28 [95% CI 1.08–1.51], respectively). Digoxin use was also associated with increased risk of cardiovascular death (RR: 1.32 [95% CI 1.07–1.64]), arrhythmic death (RR: 1.38 [95% CI 1.07–1.79]), and stroke (RR: 1.20 [95% CI 1.004–1.44]). Digoxin treatment is associated with an absolute risk increase of 19 (95% CI 13–26) additional deaths from any cause per 1000 person-years.Digoxin use is associated with a significant increased risk for death from any cause in patients with AF. This finding suggests a need for reconsideration of present treatment recommendations on use of digoxin in AF.

show abstract

“…Similarly, Cheng et al also reported an increased risk of cardiovascular mortality during current use but not former use (365 days) [59]. A study suggested that the risk of mortality could only be observed when the follow-up periods were extended to more than two years [16].…”

Section: Strength and Limitation Of The Reviewmentioning

confidence: 99%

“…per prescriptions/ per patients/ per patient years), therefore we could not summarize the total number of patients in exposed and non-exposed groups. [59]. Thirdly, different RCTs had different definitions of outcomes so it might lead to a certain degree of heterogeneity for our primary outcome.…”

Section: Strength and Limitation Of The Reviewmentioning

confidence: 99%

Managing Cardiovascular Risk of Macrolides: Systematic Review and Meta-Analysis

et al. 2017

View full text Add to dashboard Cite

(150-250 words, 250 words)Introduction It was postulated that antibiotics including macrolides could be used for secondary prevention of coronary heart disease but recent studies showed that macrolides increase the cardiovascular risk. We aimed to review the evidence of cardiovascular risk associated with macrolides regarding duration of effect and risk factors; and explore the potential effect of statins for the prevention of cardiovascular events due to macrolide use.Methods Several electronic databases(PubMed, EMBASE, Cochrane library) were searched to identify eligible studies. Observational studies and randomized controlled trials(RCTs) that investigated the association between macrolides and cardiovascular events in adults aged≥18 years were included. Meta-analysis was conducted to investigate the short and long-term risks of cardiovascular mortality, myocardial infarction, arrhythmia and stroke. Methodological quality was assessed by the Newcastle-Ottawa scale and the Cochrane Collaboration's tool. The body of evidence was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation guidelines.Results Observational studies were found to have short-term risk of cardiovascular outcomes including cardiovascular mortality, myocardial infarction and arrhythmia associated with macrolides but no risk was found in RCTs. However no association for long-term risk (>3 years) was observed in observational studies or RCTs. LimitationsThe included studies reported different units of denominators for absolute risk and used different outcome definitions, which might increase the heterogeneity. ConclusionsMore studies are required to investigate the short-term cardiovascular outcomes associated with different types of macrolides. Future studies are warranted to evaluate the effect of statins for preventing excess acute cardiovascular events associated with clarithromycin or other macrolides. Keypoints The short-term risk of cardiovascular outcomes associated with macrolides was found in observational studies but not in randomised controlled trials. No long-term cardiovascular risk (>3 years) associated with macrolides was observed.2  There was limited evidence for the use of statins to prevent excess acute cardiovascular events associated with clarithromycin or other macrolides.

show abstract

The Role of Macrolide Antibiotics in Increasing Cardiovascular Risk

Abstract: Administration of macrolide antibiotics is associated with increased risk for SCD or VTA and cardiovascular death but not increased all-cause mortality.

Cited by 134 publications

References 31 publications

Is clarithromycin a potential treatment for cachexia in people with lung cancer? A feasibility study

Is clarithromycin a potential treatment for cachexia in people with lung cancer? A feasibility study

Digoxin Use and Adverse Outcomes in Patients With Atrial Fibrillation

Managing Cardiovascular Risk of Macrolides: Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About