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

Wong, AYS; Chan, EW; Anand, S; Worsley, AJ; Wong, ICK; (2017) Managing Cardiovascular Risk of Macrolides: Systematic Review and Meta-Analysis. Drug Safety , 40 (8) pp. 663-677. 10.1007/s40264-017-0533-2. Green open access

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Abstract

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.

Type: Article
Title: Managing Cardiovascular Risk of Macrolides: Systematic Review and Meta-Analysis
Location: New Zealand
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s40264-017-0533-2
Publisher version: http://doi.org/10.1007/s40264-017-0533-2
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Clarithromycin, Azithromycin, Macrolides, Roxithromycin, High Baseline Cardiovascular Risk
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
URI: https://discovery.ucl.ac.uk/id/eprint/1546456
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