The Effect of Antidepressants on Cardiovascular Morbidity and Mortality: A Population-based Cohort Study
Kennedy, Gregory L.
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Background: Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and venlafaxine have the potential to exert beneficial effects on the heart via serotonin mediated antiplatelet activity. However, previous evidence regarding the cardiovascular effects of these agents has been conflicting. There is a need for further investigation into the risks and benefits of these drugs. Objective: To assess the risk of acute MI and cardiac death associated the use of various classes of antidepressants, and determine whether this risk is modified by the presence of predisposing factors. Methods: We identified a population-based, retrospective cohort study of 71,253 elderly persons initiating treatment with an antidepressant between 1997 and 2004. The cohort was analyzed using nested case-control approach with each case of acute MI or cardiac death matched with up to 20 controls according to age (±1 year), duration of follow-up, and year of cohort entry. Rate ratios for acute MI and cardiac death associated with the current use of various antidepressants were estimated using conditional logistic regression and adjusted for potential confounders. Results: Compared with the current use of atypical antidepressants, current use of venlafaxine was associated with a significant reduction in the risk of MI and cardiac death (rate ratio [RR] 0.80 [95% CI 0.66 to 0.97]) that was more pronounced in persons with established cardiovascular disease (CVD) (RR 0.65 [CI 0.50 to 0.86]). We found no clear evidence of a benefit or harm associated with the use of SSRIs (RR 0.92 [CI 0.79 to 1.06]), although there was the suggestion of a clinically important benefit from treatment with SSRIs for individuals who had history of MI (RR 0.68 [CI 0.44 to 1.07]). No benefit or harm was observed with other classes of antidepressants. Conclusions: These results demonstrate a reduced risk for acute MI and cardiac death associated with current use of venlafaxine among elderly persons. This beneficial effect appears to be more pronounced in those with established cardiovascular disease. No clear evidence of benefit on CV outcomes was associated with the current use of SSRIs, although results suggest a potential benefit for use in persons with a previous MI.