Antibiotic Use Linked With Increased Risk Of Heart Attack And Stroke In Women. Here’s Why

Antimicrobial Resistance Awareness Week 2023: Antibiotic use over a long period of time is linked with increased risk of heart attack or stroke in women. A study, conducted in about 36,500 women, found that women in their late adulthood (age 60 and above) who consumed antibiotics for two months or more had the greatest risk of cardiovascular disease, which could be coronary heart disease or stroke. In middle-aged women (age 40 to 59) with a long duration of antibiotic use too, an increased risk of cardiovascular disease was observed.

However, no increased risk from antibiotic use was observed in younger adults aged between 20 to 39 years. 

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How antibiotic use is linked with increased risk of cardiovascular disease

The study describing the findings was published in the European Heart Journal in 2019. 

In a statement released by the European Society of Cardiology, Professor Lu Qi, who led the research, said that a possible reason why antibiotic use is linked to an increased risk of cardiovascular disease is that antibiotics alter the balance of the gut microflora, or the microenvironment in the gut. Good bacteria, or probiotic bacteria are destroyed, and the prevalence of viruses, bacteria, or other microorganisms that can cause disease increases. 

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He explained that the most critical factor in altering the balance of microorganisms in the gut is antibiotic use, and that previous studies have shown a link between alterations in the gut microenvironment and inflammation and narrowing of the blood vessels, stroke and heart disease.

The average follow-up period of the study was about eight years. During this follow-up period, the women completed questionnaires every two years. As many as 1056 participants had developed cardiovascular disease. 

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According to the study, women who consumed antibiotics for periods of two months or longer in late adulthood had a 32 per cent more likelihood of developing cardiovascular disease than women who did not use antibiotics, and middle-aged women who consumed antibiotics for two months or longer had a 28 per cent increased risk of developing cardiovascular disease than women who did not. 

The study said that among women who consumed antibiotics for two months or more in late adulthood, six women per 1,000 women would develop a cardiovascular disease, while among women who did not take antibiotics, three per 1,000 women would develop a cardiovascular disease.

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As women grow older, they are more likely to consume antibiotics, and this can be a possible reason behind why there is a stronger link between antibiotic use in older age and increased risk of cardiovascular disease. 

If one uses antibiotics when they are not required, or consumes antibiotics for a prolonged period of time, one’s immunity is affected, and this can increase the risk of cardiovascular disease, according to Dr Tushar Tayal, Consultant, Internal Medicine at CK Birla Hospital, Gurugram.

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Prolonged antibiotic use encourages growth of bad bacteria, produces harmful chemicals

Not only do antibiotics kill good bacteria in the intestines that improve one’s health, but also encourage the growth of bad bacteria that are pathogenic. A certain type of bad bacteria produces a chemical called trimethylamine. The bad bacteria produce trimethylamine from foods such as red meat, egg yolks, and products containing carnitine, a compound involved in metabolism and which converts fat into energy. In the liver, trimethylamine is converted into a substance called trimethylamine N-oxide. When there are high levels of trimethylamine N-oxide in the body, it increases inflammation and the risk of blood clots. These factors increase the risk for heart attacks and strokes.

“Antibiotics can kill off good bacteria in the intestines that promote health. And they encourage the growth of bad bacteria that cause disease. One type of bad bacteria produces a chemical called TMA. The bacteria create TMA from foods we eat like red meat, egg yolks, and products containing carnitine. TMA is converted by the liver into a substance called TMAO. And high levels of TMAO increase inflammation and the risk of blood clots. Both of these factors raise the risk for heart attacks and stroke,” Dr Viveka Kumar, Principal Director, Cardiology, Max Super Speciality Hospital, Saket, told ABP Live. 

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Clarithromycin increased short-term risk of heart diseases in Hong Kong

According to a 2016 study published in the British Medical Journal (BMJ), increased short term risk of myocardial infarction (blockage of blood flow to the heart muscle), arrhythmia, and cardiac death was associated with the use of an antibiotic called clarithromycin among 3,20,000 people in Hong Kong.

“A 2016 study of more than 320,000 people in Hong Kong found that taking an antibiotic called clarithromycin increased the short-term risk of having a heart attack, developing a heart rhythm problem, or dying when the heart stopped suddenly. The heart problems occurred about two weeks after starting that antibiotic prescription,” said Dr Kumar. 

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Fluoroquinolones linked with adverse cardiac events

A 2019 study published in the journal Drug Safety found that fluoroquinolone antibiotics are linked with adverse cardiac effects. The findings showed a significant association between fluoroquinolone use and an increased risk of arrhythmia and cardiovascular mortality. Moxifloxacin was the drug ranked with the highest probability for cardiovascular adverse events, the study said.

“A rare but serious heart problem can also occur with a type of antibiotics called fluoroquinolones. They can increase the risk of tears in the main artery of the body, called the aorta. In 2018, the FDA warned that people who have a history of blockages of the aorta or high blood pressure, and the elderly should not take these drugs,” said Dr Kumar. 

The consumption of fluoroquinolones and macrolide antibiotic groups can also cause QTc prolongation, which is a phenomenon in which the heart muscle takes longer to contract and relax than usual. 

This can result in ventricular arrhythmia, which may be lethal, according to Dr Kumar. 

Macrolides are antibiotics used to manage and treat bacterial infections, and uncomplicated skin infections in paediatric patients. Some examples of macrolides used to treat sinusitis, tonsillitis, pneumonia, and pharyngitis are azithromycin, clarithromycin, and erythromycin.

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How to reduce cardiovascular disease risk associated with antibiotic use

In order to reduce cardiovascular disease risk associated with antibiotic use, one must avoid inadvertent use of antibiotics, and not consume antibiotics when suffering from viral infections. Patients suffering from cardiovascular diseases should be prescribed antibiotics without side effects on the heart and blood vessels.

“Avoid inadvertent use of antibiotics. Very often, antibiotics are prescribed for infections that are caused by viruses instead of bacteria. Antibiotics are not at all helpful for infections caused by viruses. It is important to prescribe antibiotics without cardiac side effects to patients with known cardiac diseases,” said Dr Kumar.

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Diet plays an important role in reducing cardiovascular disease risk linked with antibiotic use. If one is consuming antibiotics, they must eat fibre-rich foods, and take probiotic supplements to ensure the growth of good bacteria in the gut, and prevent bad bacteria from causing diseases. One must eat probiotic foods because they contain live bacteria that can keep the bad bacteria in check, said Dr Kumar. Probiotic foods include kimchi, kombucha tea, yoghurt, kefir, and sauerkraut. Prebiotics are found in garlic, onions, asparagus, whole wheat pasta, green peas, sweet potatoes, and other foods with a high fibre content.”

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