The risk for a first acute coronary syndrome in patients treated with different types of antidepressants: A population based nested case-control study. (15th September 2018)

• Record Type: Journal Article
• Authors: Almog, Ronit; Carasso, Shemy; Lavi, Idit; Amir, Offer
• Is Part Of: International journal of cardiology. Volume 267(2018)
• Page Start: 28
• Page End: 34
• Publication Date: 2018-09-15
• Subjects: Antidepressants -- Acute coronary syndrome; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.04.137
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Tricyclic antidepressants (TCAs) are still used in 30% of anxiety/depression cases and have been related to increased cardiovascular risk. Newer serotonin/norepinephrine reuptake inhibitors (SSRIs /SNRIs ) safety remains conflicting. Our aim was to assess the risk of a first acute coronary syndrome (ACS) in patients treated by various types of antidepressants. Methods: Study was a retrospective nested case-control of 40–80 years old northern-Israeli members of Clalit Health Services (CHS) during 1.1.2003–31.12.2013. Patients with severe psychiatric, cardiac or systemic diseases, or pre-enrollment antidepressants were excluded. Cases that had a first ACS during the study period were matched in 1:30 ratio with controls. The association between antidepressants use and ACS was tested by adjusted multivariable conditional logistic regression. Results: The cohort included 535, 315 individuals 128, 550 of whom met the exclusion/inclusion criteria. 3391 Cases with first ACS, (incidence rate of 24.6/10, 000 person years) were matched with 88, 016 controls. ACS was not associated with use of either SSRIS /SNRIS or TCAs compared with no antidepressants use. However, treatment by SSRIS /SNRIS was associated with a 36% decreased risk ACS compared to TCAs, OR = 0. 64, 95%CI (0.43–0.95), p = 0.029. Age 40–64 years, male gender and metabolic syndrome associated with reduced risk of ACS among SSRIS /SNRIS compared to TCAs users. Conclusion: In this study of patients without prior cardiovascular disease– neither antidepressant group imposed excess risk for ACS, compared to-no treatment. SSRIs treatment seemed safer compared to TCAs in regard of ACS. This study probably adds to our confidence of preferring SSRIs over TCAs in patients without prior cardiovascular disease. Highlights: Population based retrospective study assessing risk of ACS with antidepressants Compared to no-treatment TCA and SSRI/SNRI treatment showed a similar risk for ACS. Compared to TCA, SSRI/SNRIs were associated with a 36% risk reduction for a 1st ACS.