title: Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study.
abstract: OBJECTIVE
  To explore the gender- and age-specific risk of developing a first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared with people with no pharmaceutical treatment for diabetes or depression.
  
  
  METHODS
  A cohort of all Swedish residents aged 45-84 years (n = 4 083 719) was followed for a period of 3 years. Data were derived from three nationwide registers. The prescription and dispensing of antidiabetic and antidepressant drugs were used as markers of disease. All study subjects were reallocated according to treatment and the treatment categories were updated every year. Data were analysed using a Cox regression model with a time-dependent variable. The outcome of interest was first fatal or non-fatal myocardial infarction.
  
  
  RESULTS
  During follow-up, 42 840 people had a first myocardial infarction, 3511 of which were fatal. Women aged 45-64 years, receiving both antidiabetic and antidepressant drugs had a hazard ratio for myocardial infarction of 7.4 (95% CI 6.3-8.6) compared with women receiving neither. The corresponding hazard ratio for men was 3.1 (95% CI 2.8-3.6).
  
  
  CONCLUSIONS
  The combined use of antidiabetic and antidepressant drugs was associated with a higher risk of myocardial infarction compared with use of either group of drugs alone. The increase in relative risk was greater in middle-aged women than in middle-aged men.
authors.affiliation: Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, Linköping, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Rådholm
authors.affiliation: Research and Development Unit in Local Health Care, and Department of Medicine and Health Sciences, Linköping University, Motala, Sweden.
authors.forename: A-B
authors.initials: AB
authors.lastname: Wiréhn
authors.affiliation: The George Institute for Global Health, University of Sydney, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, Linköping, Sweden.
authors.forename: C J
authors.initials: CJ
authors.lastname: Östgren
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000523:psychology; D058065:Diabetic Cardiomyopathies / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents; D007004:Hypoglycemic Agents