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Use of antidepressants and the risk of cardiovascular and cerebrovascular disease: a meta-analysis of observational studies

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

This study aims to systematically review studies quantifying the associations between antidepressants (ADs) use and the risk of cardiovascular (CV) outcomes.

Methods

Medline was searched to October 2015 for full text articles in English. Prospective cohort and case-control studies were admitted if they investigated the relationship between current use of ADs as a whole, tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs), and the onset CV events. Summary relative risks (RRs) with confidence intervals (CIs) were calculated using random-effects or fixed-effects models.

Results

A total of 99,367 incident cases of CV outcomes who met inclusion criteria were identified from 22 observational studies. Compared with no users of ADs, use of SSRIs was associated with an increased risk of cerebrovascular disease (RRs, 1.24; 95% CI, 1.15 to 1.34), while the use of TCA was associated with an increased risk of acute heart disease (RRs, 1.29; 95% CI, 1.09 to 1.54).

Conclusions

The results of this meta-analysis have to be taken with caution because even though an increased risk of cerebrovascular and acute heart disease was observed respectively in SSRIs and TCA users, the estimates are characterized by a high between study heterogeneity. Moreover, it was not possible to distinguish between the effects of ADs and depression itself. Further well-designed studies are required to confirm this association.

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Author’s contributions

GC generated the study idea and wrote the final manuscript. AB and LS contributed to study search and selection; AB carried out the statistical analyses. All authors edited the manuscript and approved the final version.

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Authors and Affiliations

  1. Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy

    A Biffi, L Scotti & G Corrao

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  1. A Biffi
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  2. L Scotti
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  3. G Corrao
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Correspondence to A Biffi.

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Funding

This study was funded by grants from the Italian Ministry of the Education, University and Research (‘Fondo d’Ateneo per la Ricerca’ portion, year 2015).

Conflict of interest

GC received research support from the European Community (EC), the Italian Agency of Drug (AIFA), and the Italian Ministry for University and Research (MIUR). He took part to a variety of projects that were funded by pharmaceutical companies (i.e. Novartis, GSK, Roche, AMGEN and BMS). He also received honoraria as member of Advisory Board from Roche.

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Biffi, A., Scotti, L. & Corrao, G. Use of antidepressants and the risk of cardiovascular and cerebrovascular disease: a meta-analysis of observational studies. Eur J Clin Pharmacol 73, 487–497 (2017). https://doi.org/10.1007/s00228-016-2187-x

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  • DOI: https://doi.org/10.1007/s00228-016-2187-x

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