title: The Association between Antidepressant Medications and Coronary Heart Disease in Brazil: A Cross-Sectional Analysis on the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil).
abstract: BACKGROUND
  Recent studies have highlighted associations between use of antidepressant medications and coronary heart disease (CHD). Tricyclic antidepressants (TCA) are not recommended in patients with CHD as they may increase morbidity and mortality. However, this class of antidepressants is freely prescribed in public health pharmacies, while access to other classes of antidepressants is restricted in Brazil. Here, we examine the associations between antidepressant use and prevalent CHD in a large cohort from Brazil.
  
  
  METHODS
  Participants included 14,994 civil servants aged 35-74 years from the baseline assessment of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CHD (n = 710) included stable angina, myocardial infarction, and coronary revascularization. Univariate (unadjusted) and multivariate (adjusted) logistic regression analyses were conducted to estimate odds ratios and confidence intervals.
  
  
  RESULTS
  After full adjustment for covariates, TCA use (n = 156) was associated with a twofold increase in prevalent CHD, relative to non-use (n = 14,076). Additional sensitivity analysis revealed a threefold association for myocardial infarction (OR: 2.96, 95% CI: 1.41-6.21) and coronary revascularization (OR: 2.92, 95% CI: 1.28-6.66). There were no significant associations between antidepressant use and stable angina pectoris.
  
  
  CONCLUSIONS
  Findings highlight a strong association between TCA use and prevalent CHD. While the cross-sectional design is an important limitation of the present study, findings have important implications for the treatment of cardiac patients in Brazil.
authors: Faculty of Medicine, University Hospital, University of São Paulo , São Paulo , Brazil ; School of Psychology and Discipline of Psychiatry, University of Sydney , Sydney, NSW , Australia.
authors: Andrew H
authors: AH
authors: Kemp
authors: Faculty of Medicine, University Hospital, University of São Paulo , São Paulo , Brazil.
authors: Andre R
authors: AR
authors: Brunoni
authors: Faculty of Medicine, University Hospital, University of São Paulo , São Paulo , Brazil.
authors: Marcio S
authors: MS
authors: Bittencourt
authors: Faculty of Medicine, Federal University of Rio Grande do Sul , Porto Alegre , Brazil.
authors: Maria A
authors: MA
authors: Nunes
authors: Faculty of Medicine, University Hospital, University of São Paulo , São Paulo , Brazil.
authors: Isabela M
authors: IM
authors: Benseñor
authors: Faculty of Medicine, University Hospital, University of São Paulo , São Paulo , Brazil.
authors: Paulo A
authors: PA
authors: Lotufo
keywords: Brazil; CHD; TCA; clinical epidemiology; coronary heart disease; cross-sectional design; tricyclic antidepressants