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Antibiotics and risk of subsequent first-time acute myocardial infarction
C R Meier1, L E Derby, S S Jick
1Boston Collaborative Drug Surveillance Program, Boston University Medical Center, Lexington, Mass 02421, USA. chrmeier@bu.edu
Context:
Increasing evidence supports the hypothesis of a causal association between certain bacterial infections and increased risk of developing acute myocardial infarction. If such a causal association exists, subjects who used antibiotics active against the bacteria, regardless of indication, might be at lower risk of developing acute myocardial infarction than nonusers.
Objective:
To determine whether previous use of antibiotics decreases the risk of developing a first-time acute myocardial infarction.
Design:
Population-based case-control analysis.
Setting:
The United Kingdom-based General Practice Research Database comprising 350 general practices.
Patients:
A total of 3315 case patients aged 75 years or younger with a diagnosis of first-time acute myocardial infarction between 1992 and 1997 and 13139 controls without myocardial infarction matched to cases for age, sex, general practice attended, and calendar time.
Main Outcome Measures:
Use of antibiotics among those who did or did not have a first-time acute myocardial infarction.
Results:
Cases were significantly less likely to have used tetracycline antibiotics (adjusted odds ratio [OR], 0.70; 95% confidence interval [CI], 0.55-0.90) or quinolones (adjusted OR, 0.45; 95% CI, 0.21-0.95). No effect was found for previous use of macrolides (primarily erythromycin), sulfonamides, penicillins, or cephalosporins.
Conclusions:
The findings from this large case-control analysis provide further, albeit indirect, evidence for an association between bacterial infections with organisms susceptible to tetracycline or quinolone antibiotics and the risk of acute myocardial infarction. These results of preliminary nature should stimulate more research to further explore the role of infections in the etiology of acute myocardial infarction.
Insights
Previous use of tetracycline or quinolone antibiotics was associated with a lower risk of acute myocardial infarction. This suggests a potential link between bacterial infections and heart attack risk, warranting further investigation.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Growing evidence suggests a causal link between bacterial infections and acute myocardial infarction (AMI) risk.
- If true, antibiotic use against susceptible bacteria may reduce AMI incidence.
Purpose of the Study:
- To investigate if prior antibiotic use is associated with a decreased risk of first-time acute myocardial infarction.
Main Methods:
- Population-based case-control study utilizing the UK General Practice Research Database.
- Analyzed 3315 first-time AMI cases and 13139 matched controls (aged ≤75 years, 1992-1997).
- Assessed antibiotic usage in cases versus controls.
Main Results:
- Tetracycline antibiotic use was linked to a reduced risk of AMI (adjusted OR, 0.70; 95% CI, 0.55-0.90).
- Quinolone antibiotic use also showed a significant reduction in AMI risk (adjusted OR, 0.45; 95% CI, 0.21-0.95).
- No significant association was found for macrolides, sulfonamides, penicillins, or cephalosporins.
Conclusions:
- Findings provide indirect support for an association between bacterial infections (susceptible to tetracyclines/quinolones) and AMI risk.
- Results suggest the need for further research into the role of infections in the etiology of acute myocardial infarction.