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Meta-Analysis
. 2014 Oct;78(4):727-37.
doi: 10.1111/bcp.12383.

Antidepressant use and risk of coronary heart disease: meta-analysis of observational studies

Seung-Won Oh  1 , Joonseok Kim, Seung-Kwon Myung, Seung-Sik Hwang, Dae-Hyun Yoon
Affiliations
Meta-Analysis

Antidepressant use and risk of coronary heart disease: meta-analysis of observational studies

Seung-Won Oh et al. Br J Clin Pharmacol. 2014 Oct.

Abstract

Aims: Our goal was to evaluate the association between antidepressant use and the risk of coronary heart disease (CHD) among subjects with no history of coronary heart disease.

Methods: A search of Medline, EMBASE, PsycINFO and the Cochrane Library was performed in January 2013. Two authors independently reviewed and selected eligible observational studies, based on predetermined selection criteria. Pooled relative risks (RRs) with confidence intervals (CIs) were calculated using random-effects or fixed-effects models.

Results: Sixteen observational studies (seven case-control studies and nine cohort studies) were included in the final analysis. There was no association between selective serotonin reuptake inhibitor use and the risk of CHD overall [odds ratio (OR), 0.93; 95% CI, 0.65-1.33] or in subgroup meta-analysis of case-control studies (OR, 0.91; 95% CI, 0.60-1.37) and cohort studies (RR, 0.96; 95% CI, 0.59-1.55). The use of tricyclic antidepressant was associated with an increased risk of CHD overall (OR, 1.51; 95% CI, 1.07-2.12), but it was observed only in case-control studies (OR, 1.56; 95% CI, 1.24-1.96) and low-quality studies (OR, 1.49; 95% CI, 1.20-1.85) in the subgroup meta-analyses.

Conclusions: This meta-analysis of observational studies in subjects with no history of CHD suggests that neither selective serotonin reuptake inhibitor nor tricyclic antidepressant use is associated with an increased risk of CHD.

Keywords: antidepressant; coronary heart disease; meta-analysis; myocardial infarction; selective serotonin reuptake inhibitor; tricyclic antidepressant.

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Figures

Figure 1
Figure 1
Flow diagram of identification of relevant studies
Figure 2
Figure 2
(A) Association of selective serotonin reuptake inhibitor (SSRI) use and risk of coronary heart disease by type of study design. (B) Association of tricyclic antidepressant (TCA) use and risk of coronary heart disease by type of study design
Figure 3
Figure 3
(A) Begg's funnel plot and Egger's test risk for identifying publication bias in the studies on SSRI use (Egger's test, P for bias = 0.401). (B) Begg's funnel plot and Egger's test risk for identifying publication bias in the studies on TCA use (Egger's test, P for bias = 0.725)
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