Supplementary Material for: The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis
Maslej M.M.
Bolker B.M.
Russell M.J.
Eaton K.
Durisko Z.
Hollon S.D.
Swanson G.M.
Thomson Jr. J.A.
Mulsant B.H.
Andrews P.W.
10.6084/m9.figshare.5401735.v1
https://karger.figshare.com/articles/journal_contribution/Supplementary_Material_for_The_Mortality_and_Myocardial_Effects_of_Antidepressants_Are_Moderated_by_Preexisting_Cardiovascular_Disease_A_Meta-Analysis/5401735
<p><b><i>Background:</i></b> Antidepressants (ADs) are commonly
prescribed medications, but their long-term health effects are debated.
ADs disrupt multiple adaptive processes regulated by evolutionarily
ancient biochemicals, potentially increasing mortality. However, many
ADs also have anticlotting properties that can be efficacious in
treating cardiovascular disease. We conducted a meta-analysis assessing
the effects of ADs on all-cause mortality and cardiovascular events in
general-population and cardiovascular-patient samples. <b><i>Methods:</i></b>
Two reviewers independently assessed articles from PubMed, EMBASE, and
Google Scholar for AD-related mortality controlling for depression and
other comorbidities. From these articles, we extracted information about
cardiovascular events, cardiovascular risk status, and AD class. We
conducted mixed-effect meta-analyses testing sample type and AD class as
moderators of all-cause mortality and new cardiovascular events. <b><i>Results:</i></b>
Seventeen studies met our search criteria. Sample type consistently
moderated health risks. In general-population samples, AD use increased
the risks of mortality (HR = 1.33, 95% CI: 1.14-1.55) and new
cardiovascular events (HR = 1.14, 95% CI: 1.08-1.21). In cardiovascular
patients, AD use did not significantly affect risks. AD class also
moderated mortality, but the serotonin reuptake inhibitors were not
significantly different from tricyclic ADs (TCAs) (HR = 1.10, 95% CI:
0.93-1.31, <i>p</i> = 0.27). Only “other ADs” were differentiable from
TCAs (HR = 1.35, 95% CI: 1.08-1.69). Mortality risk estimates increased
when we analyzed the subset of studies controlling for premedication
depression, suggesting the absence of confounding by indication. <b><i>Conclusions:</i></b> The results support the hypothesis that ADs are harmful in the general population but less harmful in cardiovascular patients.</p>
2017-09-13 09:31:38
Antidepressant medications
All-cause mortality
Cardiovascular events