title: Cerebrovascular, Cardiovascular, and Mortality Events in New Users of Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors: A Propensity Score-Matched Population-Based Study.
abstract: BACKGROUND
  Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are widely prescribed for mood and anxiety disorders. However, it is not clear whether SNRIs are more strongly associated with cardiovascular and cerebrovascular events than SSRIs.
  
  
  METHODS
  This was a propensity score-matched, population-based, cohort study of Manitobans who started an SSRI or SNRI between April 1, 1998, and March 31, 2014. The primary outcome was a composite of acute myocardial infarction (AMI), stroke, or cardiovascular-related hospitalization within 1 year of drug initiation. Each component of the primary outcome and death were analyzed separately in secondary analyses.
  
  
  RESULTS
  A total of 225,504 and 54,635 patients initiated treatment on an SSRI and SNRI, respectively. After propensity score matching, a higher risk was observed for the primary outcome among SNRI users (weighted hazards ratio [HR], 1.13; 95% confidence interval [CI], 1.06-1.21). Secondary analyses showed that the risk of nonfatal stroke was higher among SNRI users (weighted HR, 1.20; 95% CI, 1.08-1.33). The risk of death was higher among SNRI users without mood and/or anxiety disorders (weighted HR, 1.17; 95% CI; 1.03-1.32). No differences were observed in the risk of AMI or fatal stroke between SSRI and SNRI use.
  
  
  CONCLUSIONS
  New SNRI use was associated with a higher risk of nonfatal stroke relative to SSRI use. Further investigation is warranted regarding the higher risk of death observed in our subgroup analysis among incident SNRI users without mood and/or anxiety disorders.
authors.affiliation: From the *College of Pharmacy, Rady Faculty of Health Sciences, Apotex Centre; †Department of Psychiatry, and ‡Manitoba Centre for Health Policy; Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Leong
authors.forename: Silvia
authors.initials: S
authors.lastname: Alessi-Severini
authors.forename: Murray W
authors.initials: MW
authors.lastname: Enns
authors.forename: Yao
authors.initials: Y
authors.lastname: Nie
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
authors.forename: James
authors.initials: J
authors.lastname: Bolton
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Prior
authors.forename: Dan
authors.initials: D
authors.lastname: Chateau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000401:mortality*; D002561:Cerebrovascular Disorders / Q000139:chemically induced* / Q000401:mortality*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy* / Q000453:epidemiology; D009203:Myocardial Infarction / Q000139:chemically induced / Q000401:mortality; D057216:Propensity Score; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000009:adverse effects*; D020521:Stroke / Q000139:chemically induced / Q000401:mortality; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors