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May 1, 2019MedicineOpen Access

Comparative cardiovascular safety of selective serotonin reuptake inhibitors (SSRIs) among Chinese senile depression patients

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Key result

Escitalopram was associated with a significantly lower risk of cardiovascular reactions compared to paroxetine (OR 0.37) in Chinese elderly patients with depression.

Why the study?

Patients with senile depression in China have a higher risk of coronary heart disease, but the cardiovascular safety of SSRIs in this population has not been evaluated.

Does escitalopram reduce cardiovascular reactions compared to other SSRIs in Chinese senile depression patients?

Comparison

Different SSRIs compared against each other

Design

Pairwise and network meta-analysis

Authors

SGShengyu GuoChangsha UniversityLCLing ChenCentral South UniversitySCSixiang ChengSoochow University

Discussion

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Implication

May inform SSRI selection to minimize cardiovascular reactions in Chinese elderly with depression; extends comparative safety data in this population.

Study Design

Type

Meta-Analysis (n=1,432)

Structured PICO

Does escitalopram reduce cardiovascular reactions compared to other SSRIs in Chinese senile depression patients?

P
Population
1,432 elderly Chinese patients (aged ≥60 years) with depression included in a network meta-analysis of 15 trials to evaluate the cardiovascular safety of SSRIs.
I
Intervention
Selective serotonin reuptake inhibitors (SSRIs) as a class (citalopram, escitalopram, fluoxetine, paroxetine, sertraline)
C
Comparator
Other SSRIs within the network meta-analysis
O
Outcome
Number of cardiovascular reactions when each SSRI drug was usedsafety

Main Result

Odds Ratio: 0.37 (95% CI 0.14–0.77)

In Chinese elderly patients with depression, escitalopram demonstrated the most favorable cardiovascular safety profile among SSRIs, while fluoxetine was associated with the highest risk of cardiovascular reactions.

Limitations

  • All included studies were published in Chinese, which may introduce publication bias.
  • Drug safety was not a predefined outcome in the included studies and may not have been accurately evaluated.
  • Different diagnostic criteria (ICD-10 and CCMD-3) were used across the included studies.
  • Significant variation existed in the number of studies for each comparison, resulting in wide confidence intervals for summary statistics.
  • All included studies were published in Chinese, which may introduce publication bias
  • Drug safety was not a predefined outcome and may not have been accurately evaluated
  • Use of 2 different diagnostic criteria (ICD-10 and CCMD-3) may influence the result
  • Significant variation existed in the number of studies with respect to each comparison, resulting in wide CIs

Cite This Study

Guo et al. (2019) conducted a meta-analysis in Senile depression (n=1,432). Escitalopram vs. Paroxetine was evaluated on Incidence of cardiovascular reactions (OR 0.37, 95% CI 0.14-0.77). Escitalopram was associated with a significantly lower risk of cardiovascular reactions compared to paroxetine (OR 0.37) in Chinese elderly patients with depression.

synapsesocial.com/papers/6a7f19419dbaade951d0ae79https://doi.org/10.1097/md.0000000000015786

Topics

Women and heart disease
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis2017 · 373 citations
  2. 2Meta-Analysis of Selective Serotonin Reuptake Inhibitor–Associated QTc Prolongation2014 · 252 citations
  3. 3Antidepressant use and risk of coronary heart disease: meta‐analysis of observational studies2014 · 40 citations
  4. 4Selective Serotonin Reuptake Inhibitors: Infrequent Medical Adverse Effects1998 · 51 citations
  5. 5A Meta-Analysis of Mental Health Treatments and Cardiac Rehabilitation for Improving Clinical Outcomes and Depression Among Patients With Coronary Heart Disease2013 · 280 citations