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Antibiotic Use and Risk of CVD in Women
Study Questions:
Is antibiotic use in women associated with cardiovascular disease (CVD)?
Methods:
The authors reviewed data from the Nurses’ Health Study, using the year 2004 as a baseline for 36,429 women free from CVD who reported antibiotic usage. Participants were stratified by reported duration of antibiotic use (none, <15 days, 15-days to 2 months, >2 months) and age: young (age 20-39 years), middle (age 40-59 years), and late (age ≥60 years). The primary outcome was the onset of CVD, defined as a combined endpoint of coronary disease and stroke, both fatal and nonfatal. Analyses adjusted for antibiotic use, traditional CVD risk factors including obesity, and use of other medications.
Results:
Overall, 1,056 participants developed CVD, with an average follow-up time of 7.6 years. Antibiotic use in young adulthood, regardless of duration, was not associated with an increased risk of CVD. There was a trend towards increased CVD risk with >2 months of antibiotic use compared to no use in middle and late adulthood (adjusted hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.04-1.85 and HR, 1.44; 95% CI, 1.13-1.85, respectively). Associations appeared to be driven by coronary events rather than strokes. When stratified by body mass index (BMI), long-term use in late adulthood was only associated with an increased CVD risk in those with BMI >30 kg/m2.
Conclusions:
Longer durations of antibiotic use in middle and older adulthood are associated with an increased risk of CVD.
Perspective:
This well-conducted study reinforces the accumulating evidence for an association between prolonged antibiotic use and CVD, and highlights the age of use and BMI as important determinants of that association. The authors note important limitations of the study; first, it is limited to women and thus may not be generalizable. Second, details on the type of antibiotics were not available. Last, underlying comorbidities leading to increased antibiotic use cannot be entirely accounted for. Whether antibiotic use itself is causal in CVD or is a surrogate for underlying disease processes remains to be determined.
Keywords: Antibiotic Prophylaxis, Anti-Bacterial Agents, Body Mass Index, Cardiovascular Diseases, Comorbidity, Coronary Disease, Obesity, Primary Prevention, Risk Factors, Stroke, Vascular Diseases, Women
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