Azithromycin and Risk of Cardiovascular Death: A Meta-Analytic Review of Observational Studies.
Recent evidence, though conflicting, suggests an association between azithromycin use and cardiovascular death. We conducted a systematic review and meta-analysis to evaluate the effect of azithromycin on risk of death. Multiple databases were searched. Authors independently screened and extracted the data from studies. Primary outcome of interest was risk of death (cardiovascular and/or noncardiovascular). Subgroup analyses were conducted to explore the source of a possible heterogeneity. Random effects model meta-analysis and hazards ratio (HR) were used to pool the data and calculate the overall effect estimate, respectively. Eight hundred twenty-eight citations, identified with 5 cohort studies that involved 2,246,178 episodes of azithromycin use, met our inclusion criteria. Azithromycin use was not associated with higher risk of death from any cause, HR = 0.99 [confidence interval (CI), 0.82-1.19], I = 54%, or cardiovascular cause, HR = 1.15 (CI, 0.66-2.00), I = 64%, but there was a moderate degree of heterogeneity. Subgroup analyses have shown no increased risk of death with azithromycin use in younger population with zero degree of heterogeneity, HR = 0.85 (CI, 0.66-1.09), I = 0%. However, current use of azithromycin (within 1-5 days of therapy) was associated with a higher risk of death among older population with mild degree of heterogeneity, HR = 1.64 (CI, 1.23-2.19), I = 4%. In summary, azithromycin use was not associated with higher risk of death particularly in younger population. Nevertheless, older population might be at higher risk of death with current use of azithromycin, and an alternative therapy should probably be considered.
1Department of Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, MO; 2Department of Medicine, University of Toledo Medical Center, Toledo, OH; 3Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia; 4Mayo Medical Library, Mayo Clinic, Rochester, MN; 5Department of Medicine, Division of Cardiology, School of Medicine, Emory University, Atlanta, GA; and 6Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO.
Aref A
AA
Bin Abdulhak
Abdur R
AR
Khan
Musa A
MA
Garbati
Abdul H
AH
Qazi
Patricia
P
Erwin
Sood
S
Kisra
Abdelrahman
A
Aly
Talha
T
Farid
Mikhael
M
El-Chami
Alan P
AP
Wimmer
D000367:Age Factors; D017963:Azithromycin / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D064887:Observational Studies as Topic
D017963:Azithromycin