title: Managing Cardiovascular Risk of Macrolides: Systematic Review and Meta-Analysis.
abstract: It was postulated that antibiotics including macrolides could be used for the secondary prevention of coronary heart disease but recent studies showed that macrolides increase the cardiovascular risk. We aimed to review the evidence of cardiovascular risk associated with macrolides regarding duration of effect and risk factors; and to explore the potential effect of statins for the prevention of cardiovascular events as a result of macrolide use.
  
  
  
  Several electronic databases (PubMed, EMBASE, Cochrane library) were searched to identify eligible studies. Observational studies and randomized controlled trials that investigated the association between macrolides and cardiovascular events in adults aged ≥18 years were included. A meta-analysis was conducted to investigate the short- and long-term risks of cardiovascular mortality, myocardial infarction, arrhythmia, and stroke. Methodological quality was assessed by the Newcastle-Ottawa scale and the Cochrane Collaboration's tool. The body of evidence was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation guidelines.
  
  
  
  Observational studies were found to have a short-term risk of cardiovascular outcomes including cardiovascular mortality, myocardial infarction, and arrhythmia associated with macrolides but no risk was found in randomized controlled trials. However, no association for long-term risk (ranging from >30 days to >3 years) was observed in observational studies or randomized controlled trials.
  
  
  
  The included studies reported different units of denominators for absolute risk and used different outcome definitions, which might increase the heterogeneity.
  
  
  
  More studies are required to investigate the short-term cardiovascular outcomes associated with different types of macrolides. Future studies are warranted to evaluate the effect of statins for preventing excess acute cardiovascular events associated with clarithromycin or other macrolides.
authors.affiliation: Centre 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.
authors.forename: Angel Y S
authors.initials: AYS
authors.lastname: Wong
authors.affiliation: Centre 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.
authors.forename: Esther W
authors.initials: EW
authors.lastname: Chan
authors.affiliation: Centre 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.
authors.forename: Shweta
authors.initials: S
authors.lastname: Anand
authors.affiliation: Centre 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.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Worsley
authors.affiliation: Centre 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. i.wong@ucl.ac.uk.|Research Department of Practice and Policy, School of Pharmacy, University College London, 9-39 Brunswick Square, London, WC1N 1AX, UK. i.wong@ucl.ac.uk.
authors.forename: Ian C K
authors.initials: ICK
authors.lastname: Wong
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000401:mortality; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000401:mortality / Q000517:prevention & control; D017291:Clarithromycin / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D018942:Macrolides / Q000009:adverse effects*; D009203:Myocardial Infarction / Q000139:chemically induced; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018942:Macrolides; D017291:Clarithromycin