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Evaluation of the risk of cardiovascular events with clarithromycin using both propensity score and self‐controlled study designs
Author(s) -
Root Adrian A.,
Wong Angel Y. S.,
GhebremichaelWeldeselassie Yonas,
Smeeth Liam,
Bhaskaran Krishnan,
Evans Stephen J. W.,
Brauer Ruth,
Wong Ian Chi Kei,
Navaratnam Vidya,
Douglas Ian
Publication year - 2016
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12983
Subject(s) - clarithromycin , medicine , propensity score matching , cohort , cohort study , myocardial infarction , population , stroke (engine) , incidence (geometry) , rate ratio , helicobacter pylori , confidence interval , mechanical engineering , physics , environmental health , optics , engineering
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.