title: Relation of antibiotic use to risk of myocardial infarction in the general population.
abstract: There are conflicting reports of an association between Chlamydia pneumoniae (C. pneumoniae) infection and coronary artery disease (CAD); randomized trials of antibiotics for the secondary prevention of CAD are currently underway. Physicians may be tempted to believe that their choice of antibiotic class in treating any infection may alter the risk of CAD. Our objective was to determine if the use of antibiotics with antichlamydial activity in the general population reduces the risk of myocardial infarction. A healthcare claims database with 354,258 patients with continuous health and pharmacy coverage for at least 2 years between January 1, 1991 and December 31, 1997 was used for the analyses. Hazard ratios were derived from proportional hazards models with time-dependent covariates, relating antibiotic prescription to first claim related to incident first myocardial infarction during the observation period, adjusting for previous CAD, age, sex, diabetes, hypertension, hyperlipidemia, and chronic obstructive pulmonary disease. There were a total of 1,684,091 person-years of observation and 16,139 incident myocardial infarctions. The adjusted hazard ratios were 1.10 (95% confidence intervals [CI] 1.04 to 1.16) for macrolides, 1.20 (95% CI 1.13 to 1.26) for quinolones, 1.10 (95% CI 0.96 to 1.21) for cephalosporins, 1.00 (95% CI 0.96 to 1.06) for tetracyclines, 1.01 (95% CI 0.96 to 1.06) for penicillins, and 1.13 (95% CI 0.98 to 1.30) for trimetroprim-sulfamethoxazole. The hazard ratios for individual antibiotics with activity against C. pneumoniae within each group were similar. Use of antibiotics with activity against C. pneumoniae does not reduce the risk of myocardial infarction in the general population.
authors.affiliation: Division of General Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA. jal94@columbia.edu
authors.forename: José A
authors.initials: JA
authors.lastname: Luchsinger
authors.forename: Ariel
authors.initials: A
authors.lastname: Pablos-Méndez
authors.forename: Charles
authors.initials: C
authors.lastname: Knirsch
authors.forename: Daniel
authors.initials: D
authors.lastname: Rabinowitz
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D023521:Chlamydophila Infections / Q000188:drug therapy*; D016993:Chlamydophila pneumoniae; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007341:Insurance; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000517:prevention & control*; D010406:Penicillins / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D016016:Proportional Hazards Models; D015363:Quinolones / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013754:Tetracyclines / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D018942:Macrolides; D010406:Penicillins; D015363:Quinolones; D013754:Tetracyclines; D015662:Trimethoprim, Sulfamethoxazole Drug Combination