Use of fluoroquinolones and may increase the risk of aortic and mitral regurgitation

1. Patient data from a Taiwanese national database demonstrated that those who took fluoroquinolones had a greater risk of aortic and mitral regurgitation.

2. When excluding patients treated for pneumonia however, patients who took fluoroquinolones had a greater risk of mitral but not aortic regurgitation.

Evidence Rating Level: 2 (Good)

Fluoroquinolones (FQs) are broad-spectrum antibiotics used to treat a variety of infections. There is conflicting evidence for whether FQs increase the risk of aortic and mitral regurgitation. This nationwide case-crossover study thus examined the association between FQs and the risk of aortic and mitral regurgitation. Study data was retrieved from the Longitudinal Health Insurance Database 2000 (LHID2000), a subset of the National Health Insurance Research Database (NHIRD) that has been validated to be representative of the general Taiwan population. Patients over 20 years old diagnosed with aortic regurgitation (AR) or mitral regurgitation (MR) between January 1, 2000, and December 31, 2012 were included. A unidirectional case-crossover design was used without selecting controls from an external population. Antibiotics of primary interest were oral form drugs of fluoroquinolones (FQs). A total of 26,650 patients were included in the study and separated into subcohorts of patients with MR alone (n = 20,884, mean age ±SD = 49.9 ±17.6 years, male N (%) = 7,381 (35.4%)), AR alone (n = 3,940, mean age ±SD = 70.9 ± 12.9 years, male N (%) = 1,955 (49.6%)), or combined AR and MR (n = 1,866, mean age ±SD = 65.9 ± 13.9 years, male N (%) = 784 (42.0%)). Before exclusion of pneumonia diagnosed within 2 months before the index date, patients who took FQs had a significantly greater risk of AR or MR (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI] 1.30–1.77), any AR (combined AR and MR) (aOR 1.50, 95% CI 1.10–2.04), and any MR (combined AR and MR) (aOR 1.37, 95% CI 1.16–1.62). After the exclusion of pneumonia, FQs exposure was no longer significantly associated with a larger risk of any AR (P = 0.101); however, it remained significantly associated with a greater risk of MR (aOR 1.38, 95% CI 1.17–1.62) and any MR (aOR 1.25, 95% CI 1.05–1.48). Overall, study findings provide evidence that there may be an association between the use of FQs and valvular conditions. Although further information is needed to validate these findings, this may be used to inform the prescribing of physicians for patients who have a history of, or are at risk of valvular heart conditions.

Click to read the study in PLOS ONE

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