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 (SSRI/SNRI) safety remains conflicting. Our aim was 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 SSRI/SNRI or TCA compared with no antidepressants use. However, treatment by SSRI/SNRI was associated with a 36% decreased risk ACS compared to TCA, 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 SSRI/SNRI compared to TCA 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.