AUTHOR=Wu Yang , Bi Wen-Tao , Qu Li-Ping , Fan Jun , Kong Xiang-Jun , Ji Cheng-Cheng , Chen Xu-Miao , Yao Feng-Juan , Liu Li-Juan , Cheng Yun-Jiu , Wu Su-Hua 

TITLE=Administration of macrolide antibiotics increases cardiovascular risk

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1117254

DOI=10.3389/fcvm.2023.1117254

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>The increased risk of cardiovascular events in patients prescribed macrolides has been subject to debate for decades.</p></sec><sec><title>Methods</title><p>Medline, EMBASE databases and <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link> were searched from inception until August 31, 2022 for studies investigating the link between macrolides and cardiovascular risk. A meta-analysis was performed using a random-effects model.</p></sec><sec><title>Results</title><p>A total of 80 studies involving 39,374,874 patients were included. No association was found between macrolides and all-cause death. However, compared with the non-macrolide group, macrolides were associated with a significantly increased risk of ventricular arrhythmia or sudden cardiac death (VA or SCD) (azithromycin, relative ratio [RR]: 1.53; 95% confidence interval [CI]: 1.19 to 1.97; clarithromycin, RR: 1.52; 95% CI: 1.07 to 2.16). Besides, administration of macrolides was associated with a higher risk of cardiovascular disease (CVD) death (azithromycin, RR: 1.63; 95% CI: 1.17 to 2.27) and a slightly increased risk of myocardial infarction (MI) (azithromycin, RR: 1.08; 95% CI: 1.02 to 1.15). Interestingly, no association was observed between roxithromycin and adverse cardiac outcomes. Increased risk of VA or SCD was observed for recent or current use of macrolides, MI for former use, and CVD death for current use.</p></sec><sec><title>Conclusion</title><p>Administration of macrolide antibiotics and timing of macrolide use are associated with increased risk for SCD or VTA and cardiovascular death, but not all-cause death.</p></sec>