Selective serotonin reuptake inhibitors and myocardial infarction

Abstract

Background-Depression is an independent risk factor for myocardial infarction (MI). Selective serotonin reuptake inhibitors (SSRIs) may reduce this risk through attenuation of serotonin-mediated platelet activation in addition to treatment of depression itself. Methods and Results-A case-control study of first MI in smokers 30 to 65 years of age was conducted among all 68 hospitals in an 8-county area during a 28-month period. Cases were patients hospitalized with a first MI. Approximately 4 community control subjects per case were randomly selected from the same geographic area using random digit dialing. Detailed information regarding use of antidepressant medication as well as other clinical and demographic data were obtained by telephone interview. A total of 653 cases of first MI and 2990 control subjects participated. After adjustment, using multivariable logistic regression, for age, sex, race, education, exercise, quantity smoked per day, body mass index, aspirin use, family history of MI, number of physician encounters, and history of coronary disease, diabetes, hypertension, or hypercholesterolemia, the odds ratio for MI among current SSRI users compared with nonusers was 0.35 (95% CI 0.18, 0.68; PϽ0.01). Non-SSRI antidepressant users had a nonsignificant reduction in MI risk with wide confidence intervals (adjusted odds ratio 0.48, CI 0.17, 1.32; Pϭ0.15). However, analysis of this group was limited by the small number of exposed subjects. Conclusions-The use of SSRIs may confer a protective effect against MI. This could be attributable to the inhibitory effect SSRIs have on serotonin-mediated platelet activation or possibly amelioration of other factors associated with increased risk for MI in depression.

Platelet/Endothelial Biomarkers in Depressed Patients Treated With the Selective Serotonin Reuptake Inhibitor Sertraline After Acute Coronary Events

“…10 Although this reduction did not attain statistical significance, the study was not powered to demonstrate such a difference. However, the results are consistent with the finding of lower cardiovascular morbidity and mortality in SSRI-treated patients reported in recent epidemiologic studies [11][12][13] and a study of 137 poststroke patients treated with sertraline who were followed up for 1 year. 14 Taken together, these results suggest that SSRIs might reduce cardiovascular and cerebrovascular morbidity and mortality.…”

Effect of Antidepressants and Their Relative Affinity for the Serotonin Transporter on the Risk of Myocardial Infarction

“…5 The antiplatelet effects of SSRIs, most of which have high affinity for the serotonin transporter, have been implicated in an increased risk of gastrointestinal bleeding 6 and lower risk of MI among users of SSRIs. 7 Recently, van Walraven and colleagues 8 described an increased risk of upper gastrointestinal bleeding with increasing serotonin transporter affinity of antidepressants.…”

Effects of dipping and psychological traits on morning surge in blood pressure in healthy people

“…There is clinical evidence supporting the use of behavioral 32 and pharmacological interventions targeting depression to improve cardiovascular prognosis. 33,34 Given the well established relationship between depression and cardiovascular disease, 35 there needs to be a greater awareness of the role of depression as a cardiovascular risk factor in a normotensive population. In addition, longitudinal studies are needed to determine whether interventions aimed at decreasing depression have a positive impact on cardiovascular risk in a normotensive population.…”