Antidepressants as risk factor for ischaemic heart disease: case-control study in primary care.
OBJECTIVE
To determine whether antidepressants are a risk factor for ischaemic heart disease and to compare the risk for different subgroups of antidepressants and individual antidepressants.


METHODS
Case-control study.


METHODS
Nine general practices recruited from the Trent Focus Collaborative Research Network.


METHODS
933 men and women with ischaemic heart disease matched by age, sex, and practice to 5516 controls.


METHODS
Adjusted odds ratio for ischaemic heart disease calculated by logistic regression.


RESULTS
Odds ratios for ischaemic heart disease were significantly raised for patients who had ever received a prescription for tricyclic antidepressants even after diabetes, hypertension, smoking, body mass index, and use of selective serotonin reuptake inhibitors had been adjusted for (1.56; 95% confidence interval 1.18 to 2.05). Patients who had ever taken dosulepin (dothiepin) had a significantly raised odds ratio for ischaemic heart disease after adjustment for confounding factors and use of other antidepressants (1.67, 1.17 to 2.36). There was no significant increase in the odds ratios for amitriptyline, lofepramine, and selective serotonin reuptake inhibitors in multivariate analysis. Increasing maximum doses of dosulepin were associated with increasing odds ratios for ischaemic heart disease. Similarly, there was a significant positive trend associated with increasing numbers of prescriptions of dosulepin (adjusted odds ratio 1.52 for 1 prescription, 1.39 for 2-3, and 1.96 for >/=4, P<0.002).


CONCLUSIONS
There is good evidence for an association between dosulepin and subsequent ischaemic heart disease and for a dose-response relation.
Hippisley-Cox
J
J
Division of General Practice, University of Nottingham, Nottingham NG7 2RD. julia.hippisley-cox@nottingham.ac.uk
Pringle
M
M
Hammersley
V
V
Crown
N
N
Wynn
A
A
Meal
A
A
Coupland
C
C
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D004308:Dothiepin / Q000009:adverse effects; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000139:chemically induced*; D011320:Primary Health Care; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D004308:Dothiepin; D017367:Selective Serotonin Reuptake Inhibitors