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The Association between Antibiotic Use and the Incidence of Heart Failure: A Retrospective Case-Control Study of 162,188 Outpatients

ORCID
0000-0002-2799-2287
Affiliation
Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
Loosen, Sven H.;
ORCID
0000-0003-0012-0304
Affiliation
Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
Krieg, Sarah;
Affiliation
Internal Medicine III, University of Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany
Gaensbacher, Julia;
Affiliation
Department of Pediatric Neurology, Center of Pediatrics and Adolescent Medicine, Central Hospital Bremen, 28211 Bremen, Germany
Doege, Corinna;
ORCID
0000-0003-2496-1079
Affiliation
Department of Surgery (A), University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
Krieg, Andreas;
Affiliation
Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
Luedde, Tom;
ORCID
0000-0002-8149-8087
Affiliation
Internal Medicine III, University of Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany
Luedde, Mark;
Affiliation
Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
Roderburg, Christoph;
ORCID
0000-0002-2124-7227
Affiliation
Epidemiology, IQVIA, 60549 Frankfurt, Germany
Kostev, Karel

The pathogenesis of heart failure (HF) is multifactorial, and is characterized by structural, cellular, and molecular remodeling processes. Inflammatory signaling pathways may play a particularly understudied role in HF. Recent data suggest a possible impact of antibiotic use on HF risk. Therefore, the aim of this retrospective case-control study was to investigate the association between antibiotic use and the incidence of HF. Data from the Disease Analyzer (IQVIA) database for patients diagnosed with HF and matched non-HF controls from 983 general practices in Germany between 2000 and 2019 were analyzed. A multivariable conditional logistic regression model was performed. Regression models were calculated for all patients, as well as for data stratified for sex and four age groups. A total of 81,094 patients with HF and 81,094 patients without HF were included in the analyses. In the regression analysis, low, but not high, total antibiotic use was significantly associated with a slightly lower HF risk compared with non-antibiotic users (OR: 0.87; 95% CI: 0.85–0.90). A significantly lower HF incidence was observed for sulfonamides and trimethoprim (OR: 0.87, 95% CI: 0.81–0.93) and for macrolides (OR: 0.87, 95% CI: 0.84–0.91). High use of cephalosporins, however, was associated with an increased HF risk (OR: 1.16; 95% CI: 1.11–1.22). In conclusion, this study from a large real-world cohort from Germany provides evidence that the use of different antibiotics may be associated with HF risk in a dose-dependent manner, possibly due to involved inflammatory processes. Overall, this study should provide a basis for future research to offer new therapeutic strategies for HF patients to improve their limited prognosis.

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