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

Introduction It was postulated that antibiotics including macrolides could be used for the 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 rega...

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Bibliographic Details
Published in:Drug safety 2017-08, Vol.40 (8), p.663-677
Main Authors: Wong, Angel Y. S., Chan, Esther W., Anand, Shweta, Worsley, Alan J., Wong, Ian C. K.
Format: Article
Language:English
Subjects:
Adults
Antibiotics
Arrhythmia
Cardiovascular disease
Cardiovascular diseases
Cerebral infarction
Clarithromycin
Coronary artery disease
Drug Safety and Pharmacovigilance
Evaluation
Health risk assessment
Health risks
Heart diseases
Heterogeneity
Identification methods
Medicine
Medicine & Public Health
Meta-analysis
Mortality
Myocardial infarction
Pharmacology/Toxicology
Prevention
Quality assessment
Randomization
Risk analysis
Risk factors
Risk management
Statins
Studies
Systematic Review
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Summary:Introduction It was postulated that antibiotics including macrolides could be used for the 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 to explore the potential effect of statins for the prevention of cardiovascular events as a result of macrolide use. Methods Several electronic databases (PubMed, EMBASE, Cochrane library) were searched to identify eligible studies. Observational studies and randomized controlled trials that investigated the association between macrolides and cardiovascular events in adults aged ≥18 years were included. A 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 a short-term risk of cardiovascular outcomes including cardiovascular mortality, myocardial infarction, and arrhythmia associated with macrolides but no risk was found in randomized controlled trials. However, no association for long-term risk (ranging from >30 days to >3 years) was observed in observational studies or randomized controlled trials. Limitations The included studies reported different units of denominators for absolute risk and used different outcome definitions, which might increase the heterogeneity. Conclusions More 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.
ISSN:0114-5916
1179-1942
DOI:10.1007/s40264-017-0533-2