Risk of aortic aneurysm/aortic dissection associated with fluoroquinolones use: A meta-analysis of cohort studies

Abstract

Background

It has been shown that fluoroquinolones (FQs) use may be associated with an increased risk of aortic aneurysm (AA) and/or aortic dissection (AD).

Objectives

The aim of this meta-analysis was to systematically review and summarize the epidemiological evidence on the risk of aortic AA and/or AD following FQs use.

Design

Systematic review and meta-analysis.

Data Sources and Methods

We performed a meta-analysis using data from PubMed, Embase, and the Cochrane Library, with research conducted up to March 15, 2025. Cohort studies examining the association between FQs use and AA or AD were included. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). A combined HR with 95% CI was calculated using either a random-effects or fixed-effects model, and robustness was assessed using sensitivity analysis. This meta-analysis was registered with PROSPERO (CRD 420251012072).

Results

11 studies were included, with 81,976,958 participants. The risk of AA/AD among FQs users was found to be elevated (HR = 1.20, 95% CI: 1.06–1.35). Similar results were found for AA (HR = 1.47, 95% CI: 1.24–1.73) and AD (HR = 1.12, 95% CI: 1.04–1.22). In subgroup analysis, the gender subgroup analysis revealed a higher risk of AA/AD for males (HR = 1.16, 95% CI: 1.06–1.27) compared to females (HR = 1.09, 95% CI: 1.00–1.20). Regionally, the risk was higher in America (HR = 1.47, 95% CI: 1.12–1.93) than Europe (HR = 1.08, 95% CI: 0.98–1.19) and Asia (HR = 0.80, 95% CI: 0.61–1.05). Risk associated with FQs use within 90 days (HR = 1.20, 95% CI: 1.13–1.26) was significantly higher, while no significant increase was observed for ≥365 days (HR = 1.00, 95% CI: 0.90–1.12). The presence of hypertension (HR = 1.24, 95% CI: 1.14–1.36) was associated with a significantly higher risk of AA/AD.

Conclusion

This meta-analysis demonstrates that the use of FQs is associated with a significant risk of AA/AD. Clinicians should be aware of this risk in patients prescribed FQs, and further research is needed to elucidate the role of FQs in the development of AA/AD.