Abstract
Background
Depression is common in patients after acute coronary syndromes (ACS) and with stable coronary artery disease (CAD) and has been associated with increased mortality and morbidity. However, it is unclear whether selective serotonin receptor inhibitors (SSRIs) reduce mortality or cardiac events in patients with CAD and depression.
Objective
We conducted a systematic review and meta-analysis to assess the effects of SSRIs on cardiovascular events in depressed CAD patients.
Methods
The CENTRAL, MEDLINE, and PsycINFO databases were searched (April 2020) for randomized controlled trials (RCTs) and extended follow-up analyses of RCTs that compared SSRIs with placebo or no intervention in patients with CAD and depression. The primary outcomes were all-cause mortality, cardiovascular mortality, and myocardial infarction incidence. The results were calculated through random-effect meta-analyses and reported in terms of risk ratio (RR) with 95% confidence intervals (CI).
Results
We retrieved 8 RCTs (2 of which with extended follow-up analyses), comprising a total of 1148 patients. 7 studies only included post-ACS patients. SSRIs were associated with a significantly lower risk of myocardial infarction in patients with CAD and depression (RR 0.54, 95% CI 0.34–0.86), and in post-ACS patients with depression (RR 0.56, 95% CI 0.35–0.90). We found no statistically significant difference in all-cause mortality, cardiovascular mortality, hospitalizations, angina, congestive heart failure, or stroke incidence.
Conclusion
The use of SSRIs in post-ACS patients with depression was associated with a 44% relative risk reduction of myocardial infarction. No difference in mortality was found. Given that the quality of the evidence was low, further research is warranted.
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Availability of data and material (data transparency)
Any missing dada or material used in this article will be made available to readers upon reasonable request.
Abbreviations
- 95% CI:
-
95% Confidence interval
- ACS:
-
Acute coronary syndrome
- AD:
-
Antidepressant
- BDI:
-
Beck's depression inventory
- CAD:
-
Coronary artery disease
- CHF:
-
Congestive heart failure
- DSM-III-R:
-
Diagnostic and Statistical Manual of Mental Disorders III R
- DSM-IV:
-
Diagnostic and Statistical Manual of Mental Disorders IV
- F:
-
Female
- FU:
-
Extended follow-up analysis of an RCT
- GRADE:
-
Grading of recommendations, assessment and evaluation
- HAMD-17:
-
17 Item Hamilton rating scale for depression
- HAM-D-24:
-
24 Item Hamilton rating scale for depression
- HDRS:
-
Hamilton depression rating scale
- HF:
-
Heart failure
- HR:
-
Heart rate
- IDD:
-
Inventory to diagnose depression
- IPT:
-
Interpersonal psychotherapy
- LVEF:
-
Left ventricle ejection fraction
- M:
-
Male
- MDD:
-
Major depressive disorder
- mDD:
-
Minor depressive disorder
- MI:
-
Myocardial infarction
- NSTEMI:
-
Non-ST elevation myocardial infarction
- P:
-
Placebo
- PCI:
-
Percutaneous coronary intervention
- RCT:
-
Randomized controlled trial
- RoB2:
-
Cochrane revised tool for risk of bias in randomized trials
- RR:
-
Risk ratio
- RRR:
-
Risk ratio reduction
- SCL-90 DS:
-
90-Item symptom check list depression scale
- SCL-90-R DS:
-
90-Item symptom check list revised depression subscale
- SDS:
-
Self-rating depression scale
- SSRI:
-
Selective serotonin reuptake inhibitor
- STEMI:
-
ST elevation myocardial infarction
- UA:
-
Unstable angina
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JJF had speaker and consultant fees with Grünenthal, Fundação MSD (Portugal), TEVA, MSD, Allergan, Medtronic, GlaxoSmithKline, Novartis, Lundbeck, Solvay, BIAL, Merck-Serono, Merz, Ipsen, Biogen, Acadia, Allergan, Abbvie, Sunovion-Pharmaceuticals. FJP had consultant and speaker fees with Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, and Daiichi Sankyo. DC has participated in educational meetings and/or attended conferences or symposia (including travel, accommodation, and/or hospitality) with Bristol-Myers Squibb, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Merck Serono, Ferrer, Pfizer, Novartis, and Roche. The remaining authors do not have interests to disclose.
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Fernandes, N., Prada, L., Rosa, M.M. et al. The impact of SSRIs on mortality and cardiovascular events in patients with coronary artery disease and depression: systematic review and meta-analysis. Clin Res Cardiol 110, 183–193 (2021). https://doi.org/10.1007/s00392-020-01697-8
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DOI: https://doi.org/10.1007/s00392-020-01697-8