DIFFERENTIAL EFFECTS OF ANTIDEPRESSANT SUBGROUPS ON RISK OF ACUTE MYOCARDIAL INFARCTION: A NESTED CASE-CONTROL STUDY.

The primary objective of this study was to investigate the association between antidepressants use and the risk of Acute Myocardial Infarction (AMI).We conducted a nested case-control study using a primary care database over the period 2002-2015. From a cohort of patients aged 40-99 years old, we identified incident AMI cases and randomly selected five controls per case, matched to cases for exact age, sex and index date. Exposure to antidepressants were categorised as current- , recent-, past- and non-users. Adjusted Odds Ratio (AOR) and 95% Confidence Interval (CI) were computed using conditional logistic regression to assess the association between the current use of different antidepressants subgroups and AMI as compared to non-use. Dose and duration effects were explored.A total 24,155 incident AMI cases and 120,775 controls were included. The current use of antidepressants as a group was associated with a reduced risk (AOR=0.86; 95% CI:0.81-0.91), but mainly driven by Selective Serotonin Reuptake Inhibitors (SSRIs) (AOR=0.86; 95% CI:0.81-0.93). A reduced risk was also observed with trazodone (AOR=0.76;95%CI:0.64-0.91), and clomipramine (AOR=0.62;95%CI:0.40-0.96), whereas no significant effect was observed with other antidepressants. A duration-dependent effect was suggested for SSRIs, trazodone and clomipramine, while there was no clear dose-dependency.

This study suggests that current use of antidepressants interfering selectively with the reuptake of serotonin, and those antagonizing the 5-HT_2A receptor, are associated with a decrease in AMI risk and should be the antidepressants of choice in patients at cardiovascular risk.