TY - JOUR
T1 - Antidepressants and the Risk of Cardiovascular Events in Elderly Affected by Cardiovascular Disease
T2 - A Real-Life Investigation from Italy
AU - Biffi, Annalisa
AU - Rea, Federico
AU - Scotti, Lorenza
AU - Lucenteforte, Ersilia
AU - Vannacci, Alfredo
AU - Lombardi, Niccolò
AU - Chinellato, Alessandro
AU - Onder, Graziano
AU - Vitale, Cristiana
AU - Cascini, Silvia
AU - Ingrasciotta, Ylenia
AU - Roberto, Giuseppe
AU - Mugelli, Alessandro
AU - Corrao, Giovanni
N1 - Funding Information:
E.L. received research support from the AIFA. A.M. received research support from the AIFA, the Italian Ministry for University and Research, Gilead, and Menarini. In the last 2 years, he received personal fees as speaker/consultant from Menarini Group, IBSA, Molteni, Angelini, and Pfizer Alliance. G.C. received research support from the European Community, the AIFA, and the Italian Ministry for University and Research. He took part in a variety of projects that were funded by pharmaceutical companies (ie, Novartis, GSK, Roche, AMGEN, and BMS). He also received honoraria as a member of advisory board from Roche. Other authors declare that they have no conflict of interest to disclose.
Funding Information:
This study was funded by a research grant from the AIFA (project AIFA-FARM9LBBBL), Rome, Italy. Data analyses were performed at the Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano—Bicocca with grants from the Italian Ministry of Education, University and Research ('Fondo d'Ateneo per la Ricerca' portion, year 2015).
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Purpose The purpose of this study was to assess the possible relation between use of antidepressant (AD) drugs, that is, tricyclic ADs, selective serotonin reuptake inhibitors (SSRIs), and atypical ADs (AAs), and the risk of hospitalization for cardiovascular (CV) events among older patients with previous CV diseases. Methods A nested case-control study was carried out among patients aged 65 years and older from 5 Italian health care territorial units who were discharged for CV disease during 2008 to 2010. The cohort was composed by 344,747 individuals, and of these, 97,739 (28%) experienced hospital admission for CV events (myocardial infarction, arrhythmia, stroke, heart failure) during follow-up (until 2014) and were included as cases. Up to 5 controls were randomly selected and matched to each. A conditional logistic regression was fitted to estimate the risk of CV events associated with ADs past or current use. A within-patient comparison was performed by the case-crossover design to account the effect of depression. Findings Current users of SSRIs and AAs were at increased risk of CV events with odds ratios of 1.25 (95% confidence interval, 1.21-1.29) and 1.31 (1.25-1.37), respectively. An increased risk of arrhythmia and stroke was associated with current use of SSRIs and AAs, whereas an increased risk of heart failure was detected with current use of any ADs. The results were confirmed by the case-crossover approach. Implications Evidence that AD use is associated with an increased risk of CV events in accordance with specific mechanisms of action among older people with CV disease was added by this study.
AB - Purpose The purpose of this study was to assess the possible relation between use of antidepressant (AD) drugs, that is, tricyclic ADs, selective serotonin reuptake inhibitors (SSRIs), and atypical ADs (AAs), and the risk of hospitalization for cardiovascular (CV) events among older patients with previous CV diseases. Methods A nested case-control study was carried out among patients aged 65 years and older from 5 Italian health care territorial units who were discharged for CV disease during 2008 to 2010. The cohort was composed by 344,747 individuals, and of these, 97,739 (28%) experienced hospital admission for CV events (myocardial infarction, arrhythmia, stroke, heart failure) during follow-up (until 2014) and were included as cases. Up to 5 controls were randomly selected and matched to each. A conditional logistic regression was fitted to estimate the risk of CV events associated with ADs past or current use. A within-patient comparison was performed by the case-crossover design to account the effect of depression. Findings Current users of SSRIs and AAs were at increased risk of CV events with odds ratios of 1.25 (95% confidence interval, 1.21-1.29) and 1.31 (1.25-1.37), respectively. An increased risk of arrhythmia and stroke was associated with current use of SSRIs and AAs, whereas an increased risk of heart failure was detected with current use of any ADs. The results were confirmed by the case-crossover approach. Implications Evidence that AD use is associated with an increased risk of CV events in accordance with specific mechanisms of action among older people with CV disease was added by this study.
KW - antidepressants
KW - atypical antidepressants
KW - cardiovascular disease
KW - case-crossover study
KW - health care utilization database
KW - nested case-control study
KW - selective serotonin reuptake inhibitors
KW - tricyclic antidepressants
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U2 - 10.1097/JCP.0000000000001189
DO - 10.1097/JCP.0000000000001189
M3 - Article
C2 - 32134848
AN - SCOPUS:85081532796
VL - 40
SP - 112
EP - 121
JO - Journal of Clinical Psychopharmacology
JF - Journal of Clinical Psychopharmacology
SN - 0271-0749
IS - 2
ER -