Fluoroquinolones and Risk of Aortic Aneurysm or Dissection in Patients With Congenital Aortic Disease and Marfan Syndrome

Abstract

use. 6 Fluoroquinolones are widely used because they have few major complications and are well tolerated by patients; however, they may damage connective tissue collagen and jeopardize the integrity of the extracellular matrix in the vascular wall. Studies have demonstrated that fluoroquinolones significantly increase the risk of AA/AD. 7-10 In Taiwan, fluoroquinolone use has increased from 3.6% in 2000 to 11.5% in 2013. 11 We recently demonstrated that fluoroquinolone exposure in patients with AA/AD was associated with a higher risk of later all-cause mortality, aortic-related death, and later aortic surgery. 11 LeMaire et al also demonstrated that ciprofloxacin, a type of fluoroquinolone, accelerates aortic root enlargement and A ortic aneurysm (AA) and aortic dissection (AD) are acute life-threatening conditions; therefore, identifying risk factors for AA and AD is crucial, particularly in high-risk populations. 1 Marfan syndrome is an autosomal-dominant connective tissue disorder that can lead to aortic enlargement, AA, and AD. 2-4 A recent national database study from Taiwan revealed that approximately 10% of patients with Marfan syndrome developed AD during the follow-up 12 years, and half the patients who developed AD experienced sudden death before the age of 40 years. 5 Fluoroquinolones are among the most commonly used antibiotics in the US, accounting for 5% of total antibiotic