The impact of antibiotics on heart disease

Recent information has brought to light the use of antibiotics among cardiovascular patients and resulted in some changes in how they are prescribed for those with certain conditions. Antibiotics are officially defined by the National Institutes of Health (NIH) as strong medicines designed to fight bacterial infections. They can be life-saving. They kill bacteria and prevent reproduction of bacteria. Antibiotics are often prescribed in treating bacteria-caused infections, pneumonia and cancer.  Other uses involve infection prevention among those who are at risk due to surgery.

Antibiotics and the heart

The American College of Cardiology (ACC) released findings that a certain class of antibiotics called macrolides has been associated with a small but significant increase in cardiac deaths. Macrolides are generally prescribed in the treatment of pneumonia, bronchitis and some sexually transmitted diseases. Erythromycin, azithromycin, clarithromycin and quinolone all qualify as macrolides.

Antibiotics are not prescribed to prevent heart disease but to prevent infection. For instance clarithromycin is often used to treat infections of the ears, skin, lungs and sinuses. It is not approved as a treatment for heart disease. But the use of it and other macrolides can have an impact on the heart.

The statistics are small relating macrolides to cardiac death. About one in 8,500 cases could be connected. However, when they are connected, sudden cardiac death and ventricular tachyarrhythmia, a very rapid heartbeat originating in the ventricles, can result.

Antibiotics and older women

In a study reported in 2018 by the American Heart Association (AHA), women ages sixty and older who used antibiotics for two months or longer showed greater risk of dying from cardiovascular disease than those of the same age who did not use antibiotics for that length of time.  The Nurses’ Health Study revealed that a correlation could be made for the same aged women who took antibiotics for the same length of time and other illnesses. Yet, in analyzing the information, a doctor quoted by AHA said that women ages 60 and up should not necessarily be afraid to take antibiotics when necessary. The prescribing physician should be made aware of any heart issues.

Changes in prescribing antibiotics for certain heart issues

Prescribing antibiotics for cardiac issues is changing.  For those with certain congenital heart defects, antibiotics are no longer recommended with the exception of a few conditions. They are the presence of congenital heart disease; a congenital heart defect repaired with a prosthetic device or material and repaired congenital heart defects where issues such as leaking exist. Prior to 2007, almost every procedure involving congenital heart defects was preceded with an antibiotic prescription.

If there is a serious risk of infective endocarditis prior to certain dental procedures, antibiotics are still recommended. Infective endocarditis (IE) refers to bacteria-caused damage to the inner lining of the heart, called the endocardium, or heart valves. Left untreated, it could cause serious heart damage or death. In some cases, antibiotics that can help prevent it are recommended.

The procedures that warrant an antibiotic prior to the operation include dental procedures for those who have a history of IE, a heart transplant with abnormal valve function or the congenital heart issues mentioned above. However, AHA now suggests that antibiotics to prevent IE may not be necessary for reproductive, urinary or gastrointestinal tract procedures.

Cardiologists are judicious when it comes to prescribing medicine, including antibiotics. If antibiotics are prescribed someone who has had a heart condition for another illness, the physician should be made aware of that person’s cardiovascular history. Additionally, before a prescription for antibiotics or any heart medication is discontinued, a physician or cardiologist should be notified.

To learn more about the impact of antibiotics on the cardiovascular system, log on to vascularhealthclinics.org.