Azithromycin is not associated with increased cardiovascular death in low-risk groups

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1. Use of azithromycin did not increase risk of cardiovascular death (CVD) in a general population of young and middle-aged adults. 

Evidence Rating Level: 2 (Good) 

Study Rundown: The study finds that azithromycin is not associated with higher risk of cardiovascular death (CVD) in a general young and middle-aged population. In contrast, the Ray, et al study (see Relevant Reading) showed near 3-fold increase in CVD with azithromycin use in high risk patients. The message is one of risk stratification – azithromycin is safe for the general population with a low baseline risk of cardiovascular disease, while one must weigh benefits against potential risks in high-risk patients prone to cardiac dysrhythmias.

Click to read the study in NEJM

Relevant Reading: Azithromycin and the risk of cardiovascular death

In-Depth [historical cohort study]: This study assessed the risk of death from cardiovascular causes associated with azithromycin use in a general population of young and middle-aged adults. The study compared rate of cardiovascular death (CVD) between the azithromycin group and no-use-of-antibiotics group, as well as between azithromycin and penicillin V groups.

The risk of CVD was significantly higher with current use (1 to 5 days, starting from the index date) of azithromycin compared to no use of antibiotics (rate ratio, RR, 2.85), this RR increases to 3.27 in sensitivity analysis (SA). Noncardiovascular death rate was also higher with current use of azithromycin (RR=1.60). In contrast, current use of azithromycin did not show a higher rate of CVD than penicillin V (RR=0.93 after adjusting for propensity scores; 95% CI, 0.56 to 1.55). This adjusted RR increased to 1.06 in SA.

The study concludes that azithromycin use is not associated with increased risk of CVD in a general young and middle-aged population.

By Xiaozhou Liu and Andrew Bishara

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