The use of tricyclic antidepressants was associated with a 35% increased risk of cardiovascular disease (HR 1.35) compared to non-users, whereas selective serotonin reuptake inhibitors showed no significant association.
Cohort (n=14,784)
Does antidepressant medication use increase the risk of incident cardiovascular disease in adults without known CVD?
Tricyclic antidepressant use, but not SSRI use, is associated with an increased risk of incident cardiovascular disease in adults without known baseline CVD.
Effect estimate: HR 1.35 (95% CI 1.03-1.77)
Absolute Event Rate: 17.9% vs 9.5%
AIMS: The association between antidepressant use and risk of cardiovascular disease (CVD) remains controversial, particularly in initially healthy samples. Given that antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are now prescribed not only for depression, but also for a wide range of conditions, this issue has relevance to the general population. We assessed the association between antidepressant medication use and future risk of CVD in a representative sample of community-dwelling adults without known CVD. METHODS AND RESULTS: A prospective cohort study of 14 784 adults (aged 52.4 ± 11.9 years, 43.9% males) without a known history of CVD was drawn from the Scottish Health Surveys. Of these study participants, 4.9% reported the use of antidepressant medication. Incident CVD events (comprising CVD death, non-fatal myocardial infarction, coronary surgical procedures, stroke, and heart failure) over 8-year follow-up were ascertained by a linkage to national registers; a total of 1434 events were recorded. The use of tricyclic antidepressants (TCAs) was associated with elevated risk of CVD multivariate-adjusted hazard ratio (HR) = 1.35, 95% confidence interval (CI), 1.03-1.77 after accounting for a range of covariates. There was a non-significant association between TCA use and coronary heart disease events (969 events, multivariate-adjusted HR = 1.24, 95% CI, 0.87-1.75). The use of SSRIs was not associated with CVD. Neither class of drug was associated with all-cause mortality risk. CONCLUSION: Although replication is required, the increased risk of CVD in men and women taking TCAs was not explained by existing mental illness, which suggests that this medication is associated with an excess disease burden.
Hamer et al. (Tue,) conducted a cohort in Healthy adults without known cardiovascular disease (n=14,784). Tricyclic antidepressants (TCAs) vs. No antidepressant medication was evaluated on Composite of fatal and non-fatal cardiovascular disease events (HR 1.35, 95% CI 1.03-1.77). The use of tricyclic antidepressants was associated with a 35% increased risk of cardiovascular disease (HR 1.35) compared to non-users, whereas selective serotonin reuptake inhibitors showed no significant association.