The risk for a first acute coronary syndrome in patients treated with different types of antidepressants: A population based nested case-control study

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 aimwas 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. (C) 2018 Elsevier B.V. All rights reserved.