Evaluation of the risk of cardiovascular events with clarithromycin using both propensity score and self-controlled study designs

Adrian A Root, Angel Y S Wong, Yonas Ghebremichael-Weldeselassie, Liam Smeeth, Krishnan Bhaskaran, Stephen J W Evans, Ruth Brauer, Ian Chi Kei Wong, Vidya Navaratnam, Ian Douglas

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)

Abstract

AIM: Some previous studies suggest a long term association between clarithromycin use and cardiovascular events. This study investigates this association for clarithromycin given as part of Helicobacter pylori treatment (HPT).

METHODS: Our source population was the Clinical Practice Research Datalink (CPRD), a UK primary care database. We conducted a self-controlled case series (SCCS), a case-time-control study (CTC) and a propensity score adjusted cohort study comparing the rate of cardiovascular events in the 3 years after exposure to HPT containing clarithromycin with exposure to clarithromycin free HPT. Outcomes were first incident diagnosis of myocardial infarction (MI), arrhythmia and stroke. For the cohort analysis we included secondary outcomes all cause and cardiovascular mortality.

RESULTS: Twenty-eight thousand five hundred and fifty-two patients were included in the cohort. The incidence rate ratio of first MI within 1 year of exposure to HPT containing clarithromycin was 1.07 (95% CI 0.85, 1.34, P = 0.58) and within 90 days was 1.43 (95% CI 0.99, 2.09 P = 0.057) in the SCCS analysis. CTC and cohort results were consistent with these findings.

CONCLUSIONS: There was some evidence for a short term association for first MI but none for a long term association for any outcome.

Original languageEnglish
Pages (from-to)512-21
Number of pages10
JournalBritish Journal of Clinical Pharmacology
Volume82
Issue number2
DOIs
Publication statusPublished - Aug 2016
Externally publishedYes

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