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Evaluation of the risk of cardiovascular events with clarithromycin using both propensity score and self-controlled study designs

Root, Adrian A.; Wong, Angel Y. S.; Ghebremichael-Weldeselassie, Yonas; Smeeth, Liam; Bhaskaran, Krishnan; Evans, Stephen J. W.; Brauer, Ruth; Wong, Ian Chi Kei; Navaratnam, Vidya and Douglas, Ian (2016). Evaluation of the risk of cardiovascular events with clarithromycin using both propensity score and self-controlled study designs. British Journal of Pharmacology, 82(2) pp. 512–521.

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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).


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.


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.


There was some evidence for a short term association for first MI but none for a long term association for any outcome.

Item Type: Journal Item
Copyright Holders: 2016 The Authors
ISSN: 1476-5381
Project Funding Details:
Funded Project NameProject IDFunding Body
Not SetG0802403/1Medical Research Council
Not SetMR/M014649/1Medical Research Council
Keywords: adverse drug reaction; cardiovascular disease; clarithromycin; pharmacoepidemiology
Academic Unit/School: Faculty of Science, Technology, Engineering and Mathematics (STEM) > Mathematics and Statistics
Faculty of Science, Technology, Engineering and Mathematics (STEM)
Item ID: 47703
Depositing User: Yonas Ghebremichael Weldeselassie
Date Deposited: 19 Dec 2016 10:19
Last Modified: 03 May 2019 09:10
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