Estimated Cardiac Risk Associated With Macrolides and Fluoroquinolones Decreases Substantially When Adjusting for Patient Characteristics and Comorbidities

Linnea A Polgreen; Benjamin N Riedle; Joseph E Cavanaugh; Saket Girotra; Barry London; Mary C Schroeder; Philip M Polgreen

doi:10.1161/JAHA.117.008074

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Estimated Cardiac Risk Associated With Macrolides and Fluoroquinolones Decreases Substantially When Adjusting for Patient Characteristics and Comorbidities

Journal article

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Peer reviewed

Estimated Cardiac Risk Associated With Macrolides and Fluoroquinolones Decreases Substantially When Adjusting for Patient Characteristics and Comorbidities

Linnea A Polgreen, Benjamin N Riedle, Joseph E Cavanaugh, Saket Girotra, Barry London, Mary C Schroeder and Philip M Polgreen

Journal of the American Heart Association, Vol.7(9), p.n/a

04/21/2018

DOI: 10.1161/JAHA.117.008074

PMCID: PMC6015293

PMID: 29680825

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Abstract

Some studies have found that antimicrobials, especially macrolides, increase the risk of cardiovascular death. We investigated potential cardiac-related events associated with antimicrobial use in a population of patients with acute myocardial infarction. For 185 010 Medicare beneficiaries, we recorded prescriptions for azithromycin, clarithromycin, levofloxacin, moxifloxacin, doxycycline, and amoxicillin-clavulanate. In the following week, we recorded death, acute myocardial infarction, atrial fibrillation or atrial flutter, a non-atrial fibrillation/atrial flutter arrhythmia, or ventricular arrhythmia. We fit unadjusted and adjusted logistic regression models using generalized estimating equations. Adjusted models included patients' comorbidities, medications, procedures, demographics, insurance status, time since index acute myocardial infarction, number of visits, and the influenza rate. In unadjusted analyses, macrolides and fluoroquinolones were associated with a risk of cardiac events. However, the risk associated with macrolide use was substantially attenuated after adjustment for a wide range of variables, and the risk associated with fluoroquinolones was no longer statistically significant. For example, for azithromycin, the odds ratio for any cardiac event or death was 1.35 (95% confidence interval, 1.27-1.44; <0.0001), but after controlling for a wide range of covariates, the odds ratio decreased to 1.01 (95% confidence interval, 0.95-1.08; <0.6688). Controlling for covariates explains much of the adverse cardiac risk associated with antimicrobial use found in other studies. Most antimicrobials are not associated with risk of cardiac events, and others, specifically azithromycin and clarithromycin, may pose a small risk of certain cardiac events. However, the modest potential risks attributable to these antimicrobials must be weighed against the drugs' considerable and immediate benefits.

Arrhythmias, Cardiac - epidemiology

Myocardial Infarction - diagnosis

Myocardial Infarction - chemically induced

United States - epidemiology

Myocardial Infarction - epidemiology

Myocardial Infarction - mortality

Arrhythmias, Cardiac - chemically induced

Prognosis

Arrhythmias, Cardiac - mortality

Medicare

Risk Assessment

Comorbidity

Humans

Risk Factors

Male

Fluoroquinolones - adverse effects

Macrolides - adverse effects

Clinical Decision-Making

Aged, 80 and over

Female

Aged

Anti-Bacterial Agents - adverse effects

Arrhythmias, Cardiac - diagnosis

Health Status

Details

Title: Subtitle: Estimated Cardiac Risk Associated With Macrolides and Fluoroquinolones Decreases Substantially When Adjusting for Patient Characteristics and Comorbidities
Creators: Linnea A Polgreen - Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA linnea-polgreen@uiowa.edu
Benjamin N Riedle - Department of Biostatistics, University of Iowa, Iowa City, IA
Joseph E Cavanaugh - Department of Biostatistics, University of Iowa, Iowa City, IA
Saket Girotra - Department of Internal Medicine, University of Iowa, Iowa City, IA
Barry London - Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA
Mary C Schroeder - Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA
Philip M Polgreen - Department of Epidemiology, University of Iowa, Iowa City, IA
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.7(9), p.n/a
DOI: 10.1161/JAHA.117.008074
PMID: 29680825
PMCID: PMC6015293
NLM abbreviation: J Am Heart Assoc
ISSN: 2047-9980
eISSN: 2047-9980
Publisher: England
Grant note: K25 HL122305 / NHLBI NIH HHS K08 HL122527 / NHLBI NIH HHS
Language: English
Date published: 04/21/2018
Academic Unit: Statistics and Actuarial Science; Molecular Physiology and Biophysics; Infectious Diseases; Epidemiology; Economics; Biostatistics; Cardiovascular Medicine; Pharmacy Practice and Science; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9983985891802771

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