Risk for cardiovascular disease in patients with nontuberculous mycobacteria treated with macrolide.

BACKGROUND

Macrolide antibiotics are the most important pharmacological agents for the treatment of nontuberculous mycobacterial disease. We investigated the incidence of acute cardiovascular events in patients taking macrolides for nontuberculous mycobacterial disease and determined the difference in risk between clarithromycin and azithromycin.

METHODS

A population-based retrospective cohort study was conducted in South Korea using the Health Insurance Review and Assessment Service database. Patients ≥40 years treated with macrolide for nontuberculous mycobacteria (NTM) between 2011 and 2015 were examined. The primary outcome was hospitalization or emergency department visit for cardiovascular disease along with acute myocardial infarction, cerebrovascular disease, and cardiac arrhythmia. The standardized incidence ratio (SIR) for cardiovascular disease was calculated by comparing the patients with the general population in the year 2013. Cox proportional hazard model was used to compare the risk between clarithromycin and azithromycin.

RESULTS

In total, 16,525 patients with nontuberculous mycobacterial disease treated with macrolide were included; 13,870 received clarithromycin and 2,655 received azithromycin. The cardiovascular incidence was significantly higher in patients with nontuberculous mycobacterial disease than in the age- and sex-stratified general population [SIR, 1.44; 95% confidence interval (CI), 1.27-1.61]. The risk was not significantly different between patients treated with clarithromycin and azithromycin (adjusted hazard ratio, 0.90; 95% CI, 0.65-1.24).

CONCLUSIONS

The incidence of cardiovascular disease was significantly higher in patients treated with macrolide for nontuberculous mycobacterial disease than in the general population. This risk was not different between patients treated with clarithromycin and azithromycin.