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Fluoroquinolones and the risk of aortopathy: A systematic review and meta-analysis

  • Anas T. Noman
    Affiliations
    Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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  • Abdul H. Qazi
    Affiliations
    Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
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  • Musab Alqasrawi
    Affiliations
    Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
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  • Hakeem Ayinde
    Affiliations
    Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
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  • Imad M. Tleyjeh
    Affiliations
    Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA

    Department of Epidemiology, Mayo Clinic, Rochester, MN, USA

    Department of Medicine, Infectious Diseases Section, King Fahad Medical City, PO Box 59046, Riyadh 11525, Saudi Arabia

    College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
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  • Paul Lindower
    Affiliations
    Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
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  • Aref A. Bin Abdulhak
    Correspondence
    Corresponding author at: Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Dr., E 315 GH, Iowa City, IA 52242, USA.
    Affiliations
    Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
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Published:September 21, 2018DOI:https://doi.org/10.1016/j.ijcard.2018.09.067

      Highlights

      • Fluoroquinolones use is associated with elevated risk of aortic aneurysm.
      • Fluoroquinolones use is associated with elevated risk of aortic dissection.
      • 1376 treatment of fluoroquinolones are estimated to cause an episode of aortopathy.

      Abstract

      Objective

      To investigate the association between fluoroquinolones use and development of aortopathy.

      Methods

      A systematic review and meta-analysis was conducted following PRISMA and MOOSE guidelines for reporting systematic reviews of observational studies. Multiple databases were searched and two authors independently screened studies for eligibility. Newcastle Ottawa scale was used to assessed the quality of included studies. Primary outcome of interest was development of aortic aneurysm or dissection among fluoroquinolones users in comparison to non-users. An inverse variance model meta-analysis was used to pool odds ratio or hazards ratio from included studies to calculate the overall effect estimate. Pre specified subgroups analyses were also conducted to explore sources of heterogeneity.

      Results

      Three observational studies that enrolled 941,639 subjects met the inclusion criteria and were included in the final analysis. All studies were of a good methodological quality. Current use of fluoroquinolones, defined as within 60 days from development of the primary outcome, was associated with significantly elevated risk of developing aortic aneurysm and/or dissection in comparison to controls, (OR = 2.04; 95% CI [1.67, 2.48]). There was only a mild degree of between study heterogeneity, I2 = 33%. The association remains robust among all subgroups analyses.

      Conclusion

      Our findings indicate that current fluoroquinolone use was significantly associated with increased risk of aortic aneurysm and dissection. Health care providers need to be aware of this serious association and use fluoroquinolones judiciously in order to minimize the risk of the serious sequela of aortopathy.
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