Use of antidepressants and the risk of cardiovascular and cerebrovascular disease: a meta-analysis of observational studies
Use of antidepressants and the risk of cardiovascular and cerebrovascular disease: a meta-analysis of observational studies
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DOI：
10.1007/s00228-016-2187-x
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发表时间：
2017-04-01
影响因子：
2.9
通讯作者：
Corrao, G.
中科院分区：
文献类型：
--
作者：
Biffi, A.;Scotti, L.;Corrao, G.
目的：本研究旨在系统回顾量化抗抑郁药(ADS)使用与心血管风险之间关系的研究。方法应用计算机检索Medline2015年10月的英文全文文章。如果研究ADS整体、三环抗抑郁药(TCA)或选择性5-羟色胺再摄取抑制剂(SSRIs)的当前使用与发病的CV事件之间的关系，则纳入前瞻性队列和病例对照研究。结果22项观察性研究共鉴定出99,367例符合纳入标准的心血管事件结局病例。与未使用ADS的患者相比，使用SSRIs的患者患脑血管疾病的风险增加(RRS，1.24；95%CI，1.15~1.34)，而使用TCA的患者患急性心脏病的风险增加(RRS，1.29；95%CI，1.09~1.54)。结论尽管SSRIs和TCA用户分别观察到脑血管疾病和急性心脏病的风险增加，但这一荟萃分析的结果仍需谨慎对待。此外，无法区分广告的影响和抑郁本身。需要进一步的精心设计的研究来证实这种联系。
Purpose This study aims to systematically review studies quantifying the associations between antidepressants (ADs) use and the risk of cardiovascular (CV) outcomes.Methods Medline was searched to October 2015 for full text articles in English. Prospective cohort and case-control studies were admitted if they investigated the relationship between current use of ADs as a whole, tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs), and the onset CV events. Summary relative risks (RRs) with confidence intervals (CIs) were calculated using random-effects or fixed-effects models.Results A total of 99,367 incident cases of CV outcomes who met inclusion criteria were identified from 22 observational studies. Compared with no users of ADs, use of SSRIs was associated with an increased risk of cerebrovascular disease (RRs, 1.24; 95% CI, 1.15 to 1.34), while the use of TCA was associated with an increased risk of acute heart disease (RRs, 1.29; 95% CI, 1.09 to 1.54).Conclusions The results of this meta-analysis have to be taken with caution because even though an increased risk of cerebrovascular and acute heart disease was observed respectively in SSRIs and TCA users, the estimates are characterized by a high between study heterogeneity. Moreover, it was not possible to distinguish between the effects of ADs and depression itself. Further well-designed studies are required to confirm this association.