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

Angel Y S Wong1, Esther W Chan1, Shweta Anand1

  • 1Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.

Drug Safety
|April 12, 2017
PubMed
Abstract

Insights

Macrolide antibiotics may increase short-term cardiovascular risk, particularly in observational studies, but not in randomized trials. Long-term risks were not identified, and statins may help prevent macrolide-associated events.

Area of Science:

  • Cardiology
  • Pharmacology
  • Epidemiology

Background:

  • Macrolides were considered for secondary prevention of coronary heart disease.
  • Recent evidence suggests macrolides may elevate cardiovascular risk.
  • This review examines macrolide-associated cardiovascular risks and potential statin interventions.

Purpose of the Study:

  • To review evidence on cardiovascular risk from macrolides, considering duration and risk factors.
  • To explore statins' potential role in preventing macrolide-induced cardiovascular events.

Main Methods:

  • Meta-analysis of observational studies and randomized controlled trials.
  • Searched PubMed, EMBASE, and Cochrane Library for studies on macrolides and cardiovascular events.
  • Assessed risk of cardiovascular mortality, myocardial infarction, arrhythmia, and stroke.

Main Results:

  • Observational studies indicated a short-term risk of cardiovascular outcomes with macrolides.
  • Randomized controlled trials did not show an increased cardiovascular risk.
  • No long-term cardiovascular risk (>30 days to >3 years) was found in either study type.

Conclusions:

  • Further research is needed on short-term cardiovascular outcomes for specific macrolides.
  • Future studies should evaluate statins for preventing acute cardiovascular events linked to macrolides like clarithromycin.

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