A meta-analysis of antibiotic use for the secondary prevention of cardiovascular diseases

Song, Zhi; Brassard, Paul; Brophy, James M.

doi:10.1016/s0828-282x(08)70603-2

Cited by 31 publications

(19 citation statements)

References 38 publications

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“…This conclusion rests on our unselected nationwide population of IHD patients followed over a period of up to 5 years. The data, however, do correspond to the results of the multitude of other clinical trials on the subject which have suggested neither benefit nor harm in relation to macrolide treatment in patients with heart disease [6,7,16,17,18]. It is should be noted that the CLARICOR trial was deemed at risk for having potentially important baseline differences between the exposure groups in that there was an overrepresentation of smokers in the clarithromycin arm, and there were further possible issues with the external validity of the trial in that less than 50% of the patients invited were willing to participate [19].…”

Section: Discussionsupporting

confidence: 59%

“…A number of smaller trials have also been conducted to test the infection hypothesis; they have, along with the larger trials, been meta-analyzed both with [7] and without [6] the inclusion of the CLARICOR trial. Both presented concordant evidence of the lack of an association between antibiotic therapy and reduction in mortality and cardiac events in patients with coronary heart disease.…”

Section: Discussionmentioning

confidence: 99%

“…In the late 1990s, it was theorized that treatment with macrolides, to which C. pneumoniae is susceptible, could possibly have beneficial effects on cardiovascular morbidity and mortality in patients with advanced atherosclerosis. However, apart from a small pilot trial [5], no study has shown a favorable effect of antibiotic treatment [6,7]. Contrarily, one of the larger clinical trials, the Clarithromycin for Patients with Stable Coronary Artery Disease (CLARICOR) trial, demonstrated that a brief clarithromycin course for patients with stable coronary heart disease was associated with a roughly 20% higher mortality during long-term follow-up [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Clarithromycin Use and Risk of Death in Patients with Ischemic Heart Disease

et al. 2010

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Objectives: To examine whether treatment with clarithromycin was associated with an increased risk of death in patients with preexisting ischemic heart disease (IHD). Methods: Employing nationwide registers, all patients with IHD events from 1997 to 2007 who subsequently claimed prescriptions for dual antibiotic treatment for eradication treatment were identified. The primary endpoint was all-cause mortality. Results: The study included 214,330 individuals with IHD; 5,265 (2.5 %) of these claimed prescriptions for dual antibiotics. Compared with IHD patients not undergoing eradication therapy, no increase in the risk of all-cause mortality was demonstrated (HR 1.02; 95% CI 0.84–1.23, p = 0.87) after 5 years. Conclusions: The use of clarithromycin in the setting of eradication treatment for Helicobacter pylori in patients with IHD was not associated with an increased risk of death.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clarithromycin Use and Risk of Death in Patients with Ischemic Heart Disease

et al. 2010

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“…Meta-analysis data on anti-chlamydial antibiotics and cardiovascular disease from 13 studies comprising 12,491 treated patients and 12,518 controls did not show a significant benefit (RR 0.96, 95% CI 0.90-1.04) [105].…”

Section: Antimicrobial Therapymentioning

confidence: 88%

Is community-acquired pneumonia an independent risk factor for cardiovascular disease?

Singanayagam

Elder²,

Chalmers³

2011

Eur Respir J

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Community-acquired pneumonia (CAP) is the most frequent infectious cause of death in western countries. The high mortality rate in CAP is commonly related to comorbid conditions such as cardiovascular disease.Clinical studies in both primary and secondary care settings have identified an increase in shortand long-term risk of cardiovascular events and death from vascular events following acute respiratory infections. The mechanism remains to be fully established, but it has been suggested that the inflammatory state in patients affected by CAP acts to promote platelet activation and thrombosis, and to narrow coronary arteries through vasoconstriction. Acute infections destabilise vascular endothelium and create an imbalance between myocardial oxygen supply and demand, leading to an increased risk of cardiovascular events. Acute infections have been shown to have both systemic effects and local effects on coronary vessels. These effects are mediated through both the host response to infection and, in some cases, direct effects of bacterial infection or bacterial products.In this review, we discuss the link between CAP and increased risk of cardiovascular events, drawing on existing evidence from clinical and mechanistic studies. Further studies into and increased awareness of this association is warranted to promote novel ways of protecting highrisk patients.

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“…However, a diabetogenic effect of gatifloxacin was observed which resulted in withdrawal of this drug from the clinical practice. Authors of the largest metaanalysis of 13 clinical trials indicated that there was no evidence of the efficacy of antibiotic therapy in the treatment of CVD and suggested that new studies in this area were unlikely to prove the contrary [47].…”

Section: Antiplatelet Agentsmentioning

confidence: 99%