title: The Role of Macrolide Antibiotics in Increasing Cardiovascular Risk.
abstract: BACKGROUND
  Large cohort studies provide conflicting evidence regarding the potential for oral macrolide antibiotics to increase the risk of serious cardiac events.
  
  
  OBJECTIVE
  This study performed a meta-analysis to examine the link between macrolides and risk of sudden cardiac death (SCD) or ventricular tachyarrhythmias (VTA), cardiovascular death, and death from any cause.
  
  
  METHODS
  We performed a search of published reports by using MEDLINE (January 1, 1966, to April 30, 2015) and EMBASE (January 1, 1980, to April 30, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included.
  
  
  RESULTS
  Thirty-three studies involving 20,779,963 participants were identified. Patients taking macrolides, compared with those who took no macrolides, experienced an increased risk of developing SCD or VTA (RR: 2.42; 95% CI: 1.61 to 3.63), SCD (RR: 2.52; 95% CI: 1.91 to 3.31), and cardiovascular death (RR: 1.31; 95% CI: 1.06 to 1.62). No association was found between macrolides use and all-cause death or any cardiovascular events. The RRs associated with SCD or VTA were 3.40 for azithromycin, 2.16 for clarithromycin, and 3.61 for erythromycin, respectively. RRs for cardiovascular death were 1.54 for azithromycin and 1.48 for clarithromycin. No association was noted between roxithromycin and adverse cardiac outcomes. Treatment with macrolides is associated with an absolute risk increase of 118.1 additional SCDs or VTA, and 38.2 additional cardiovascular deaths per 1 million treatment courses.
  
  
  CONCLUSIONS
  Administration of macrolide antibiotics is associated with increased risk for SCD or VTA and cardiovascular death but not increased all-cause mortality.
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Yun-Jiu
authors.initials: YJ
authors.lastname: Cheng
authors.affiliation: Department of Outpatients, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xiao-Ying
authors.initials: XY
authors.lastname: Nie
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xu-Miao
authors.initials: XM
authors.lastname: Chen
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xiao-Xiong
authors.initials: XX
authors.lastname: Lin
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Tang
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Wu-Tao
authors.initials: WT
authors.lastname: Zeng
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Wei-Yi
authors.initials: WY
authors.lastname: Mei
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Li-Juan
authors.initials: LJ
authors.lastname: Liu
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Long
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Feng-Juan
authors.initials: FJ
authors.lastname: Yao
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xin-Xue
authors.initials: XX
authors.lastname: Liao
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Zhi-Min
authors.initials: ZM
authors.lastname: Du
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Yu-Gang
authors.initials: YG
authors.lastname: Dong
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Ma
authors.affiliation: Department of Endocrinology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. Electronic address: Xiaohp@mail.sysu.edu.cn.
authors.forename: Hai-Peng
authors.initials: HP
authors.lastname: Xiao
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. Electronic address: wusuhua@hotmail.com.
authors.forename: Su-Hua
authors.initials: SH
authors.lastname: Wu
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D018942:Macrolides / Q000009:adverse effects*; D008297:Male; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides
keywords: coronary heart disease; roxithromycin; sudden cardiac death; ventricular tachyarrhythmia