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. 2025 Mar 6;65(3):2401574.
doi: 10.1183/13993003.01574-2024. Print 2025 Mar.

Cardiovascular benefits and safety profile of macrolide maintenance therapy in patients with bronchiectasis

Ran Guo  1   2 , Dennis Wat  3 , Steven Ho Man Lam  4   5 , Tommaso Bucci  4   6 , Christopher Tze-Wei Tsang  1 , An-Ping Cai  7 , Yap-Hang Chan  1 , Qing-Wen Ren  1   2 , Jia-Yi Huang  1   2 , Jing-Nan Zhang  1   2 , Wen-Li Gu  1   2 , Ching-Yan Zhu  1 , Yik-Ming Hung  1 , Freddy Frost  3   4   8 , Gregory Y H Lip  4   9   8 , Kai-Hang Yiu  10   2   8
Affiliations

Cardiovascular benefits and safety profile of macrolide maintenance therapy in patients with bronchiectasis

Ran Guo et al. Eur Respir J. .

Abstract

Background: Macrolide maintenance therapy (MMT) has demonstrated notable efficacy in reducing exacerbation in patients with bronchiectasis, which is a major risk factor for cardiovascular events. However, a comprehensive assessment of the cardiovascular benefits and safety profile of MMT in this population is lacking.

Methods: This territory-wide cohort study analysed patients diagnosed with bronchiectasis in Hong Kong between 2001 and 2018. Patients were classified as MMT receivers or macrolide non-receivers based on the administration of MMT. Propensity score (PS) matching was employed for confounding factors adjustment. The primary outcome of interest was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction and stroke. The safety outcome was the occurrence of ventricular arrhythmias or sudden cardiac death. Cox proportional hazard regression analysis was utilised to compare the incidence of outcomes across the two groups.

Results: A total of 22 895 patients with bronchiectasis were identified. Following 1:2 PS matching, the final cohort consisted of 3137 individuals, with 1123 MMT receivers and 2014 macrolide non-receivers. MMT administration was associated with a significantly reduced risk of MACE (16.38 versus 24.11 events per 1000 person-years; hazard ratio (HR) 0.68, 95% CI 0.52-0.90). Importantly, the use of MMT was not associated with elevated risk of ventricular arrhythmias or sudden cardiac death (7.17 versus 7.67 events per 1000 person-years; HR 0.93, 95% CI 0.60-1.44).

Conclusions: The administration of MMT in patients with bronchiectasis was associated with a significant reduction in the risk of MACE, without any evidence suggesting an increased risk of severe arrhythmia-related adverse events.

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Conflict of interest statement

Conflict of interest: D. Wat has received speaker's fees from Chiesi, AstraZeneca, GSK, Sterling Anglian, Glenmark and Insmed. F. Frost has received speaker's fees from Chiesi, AstraZeneca and Vertex Pharmaceuticals, and support for attending meetings and travel from Chiesi. The research presented in this manuscript was conducted independently, and the authors declare that there was no impact of the conflicts of interest on the work. The remaining authors have no potential conflicts of interest to disclose.

Figures

None
Overview of the study. MMT: macrolide maintenance therapy; ICD-9: International Classification of Diseases, Ninth Revision; PSM: propensity score matching; MACE: major adverse cardiovascular events; AMI: acute myocardial infarction.
FIGURE 1
FIGURE 1
Outcomes in the 1:2 propensity score-matched macrolide maintenance therapy (MMT) receivers versus macrolide non-receivers. MACE: major adverse cardiovascular events; AMI: acute myocardial infarction.
FIGURE  2
FIGURE  2
Cumulative incidence of major adverse cardiovascular events (MACE) in the propensity score-matched cohort. MMT: macrolide maintenance therapy.
FIGURE 3
FIGURE 3
Primary outcome in propensity score-matched macrolide maintenance therapy (MMT) receivers versus macrolide non-receivers by various subgroups. CVD: cardiovascular disease; P. aeruginosa: Pseudomonas aeruginosa. History of CVDs was defined as history of acute myocardial infraction, stroke, unstable angina hospitalisation, percutaneous coronary intervention or coronary artery bypass grafting, peripheral artery diseases, congestive heart failure, or arrythmia.
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