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Antibiotic use associated with a risk of cardiovascular disease in adult women
Question clinique
Is there an association between antibiotic use and the risk of cardiovascular disease in adult women?
L’Essentiel
Print and post this POEM in every examination room. Not only is there an increased risk of breast cancer in women from antibiotic use, antibiotic use is also associated with an increased risk of cardiovascular disease (CVD). Point to this during your explanation of why antibiotics are not needed for colds, sinus infections, ear aches, coughs, sore throats, and so forth, and emphasize that there is a personal risk to unnecessary use. 1b
Référence
Plan de l'etude: Cohort (retrospective)
Financement: Government
Cadre: Population-based
Sommaire
These investigators analyzed data from the Nurses' Health Study, beginning in 2004 when information on antibiotic use was initially assessed. Of the total 90,853 women returning the 2004 questionnaire, 57,726 reported on antibiotic use during young adulthood (aged 20 - 39 years), middle adulthood (40 - 59 years), and late adulthood (60 years and older). After excluding women with cancer, incomplete demographic information, a history of CVD, and those not returning subsequent questionnaires, 36,429 eligible women in late adulthood remained in this study. Information on subsequent CVD end points and mortality was obtained by reviewing medical records and death certificates. During an average of 7.6 years of follow-up, 1056 women (2.8%) developed CVD. Multiple adjustments occurred for potential confounders, including socioeconomic status, education, diet and lifestyle, reasons for antibiotic use, body mass index, co-existing diseases (eg, diabetes, hypertension, or smoking), and other medication use. Long-term antibiotic use (at least 2 months) in middle and late adulthood significantly increased the risk of CVD (hazard ratio [HR] 1.28; 95% CI 0.95 - 1.70 and HR 1.32; 1.03 - 1.70, respectively; P trend = 0.003 for both). Antibiotic use in young adulthood was not significantly associated with an increased risk of CVD.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Commentaires
What could be the mechanism…
What could be the mechanism of this, implying antibiotics could be causative of cvd?
Maybe the patients who required antibiotics were subtly more systemically unwell and more prone to develop cvd also.
I agree with the above…
I agree with the above comment . I don't think this study proves causation. I am a little surprised that the original reviewer was not more skeptical as they usually are. (which is a good thing) I wonder if there is a a third factor, such as a subtly weakened immune surveillance, that is the root cause of all the illnesses. Something like what used to happen with AIDS, horrible infections and also malignancies.
Long term use of ABx?
When they say long-term use of antibiotics for middle/late adulthood, do they mean cumulative use (60 days total) or a period of 2 months of continuous use, which would be much rarer? This should be further clarified by the reviewer.