PMID- 17249635
OWN - NLM
STAT- MEDLINE
DCOM- 20070302
LR  - 20221207
IS  - 0706-7437 (Print)
IS  - 0706-7437 (Linking)
VI  - 51
IP  - 14
DP  - 2006 Dec
TI  - Adverse cardiovascular events in antidepressant trials involving high-risk 
      patients: a systematic review of randomized trials.
PG  - 923-9
AB  - OBJECTIVE: To examine whether selective serotonin reuptake inhibitor (SSRI) 
      antidepressants were associated with an increased or decreased risk of 
      cardiovascular adverse events (AEs). METHODS: We conducted a systematic review of 
      randomized controlled trials published between 1967 and May 2005 that treated 
      patients with cardiac disease, diabetes mellitus, stroke, geriatric age, nicotine 
      dependence, alcoholism, HIV infection, and obesity. We defined serious AEs as 
      death due to a cardiovascular cause, heart failure, stroke, transient ischemic 
      attack, and myocardial infarction. Nonserious AEs were defined as palpitations, 
      chest pain, angina, arrhythmia, hypertension, hypotension-syncope, and 
      unspecified cardiovascular or neurologic events. Adverse event rates were 
      calculated in 4 groups: SSRIs, tricyclic antidepressants (TCAs), other active 
      therapies, and placebo. RESULTS: Stroke and cardiac patients were the 
      highest-risk groups for cardiovascular AEs. We were unable to detect differences 
      in odds between SSRI and placebo for both serious (odds ratio [OR] 0.69; 95% 
      confidence interval [CI], 0.39 to 1.21) and nonserious (OR 1.18; 95% CI, 0.90 to 
      1.57) cardiovascular AEs. There was a significant decrease in the odds of 
      nonserious cardiovascular AEs (OR 0.46; 95% CI, 0.24 to 0.86, P = 0.02) for 
      patients receiving SSRIs, compared with TCAs. Over one-half of the selected 
      trials did not report the presence or absence of cardiovascular events. 
      CONCLUSIONS: This systematic review of antidepressant trials in high-risk 
      patients did not determine whether SSRIs are associated with a greater or lesser 
      risk of cardiovascular AEs. Reasons for this conclusion include the rarity of 
      serious AEs, the lack of large trials in these patients, and a lack of adequate 
      reporting of AEs in published trials. Further trials assessing the risk of 
      cardiovascular AEs and better trial reporting are needed.
FAU - Swenson, J Robert
AU  - Swenson JR
AD  - Department of Psychiatry, University of Ottawa, Ontario. 
      jrswenson@ottawahospital.on.ca
FAU - Doucette, Steve
AU  - Doucette S
FAU - Fergusson, Dean
AU  - Fergusson D
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Can J Psychiatry
JT  - Canadian journal of psychiatry. Revue canadienne de psychiatrie
JID - 7904187
RN  - 0 (Serotonin Uptake Inhibitors)
SB  - IM
MH  - Cardiovascular Diseases/*chemically induced/epidemiology
MH  - Humans
MH  - Randomized Controlled Trials as Topic
MH  - Risk Factors
MH  - Selective Serotonin Reuptake Inhibitors/*adverse effects
RF  - 30
EDAT- 2007/01/26 09:00
MHDA- 2007/03/03 09:00
CRDT- 2007/01/26 09:00
PHST- 2007/01/26 09:00 [pubmed]
PHST- 2007/03/03 09:00 [medline]
PHST- 2007/01/26 09:00 [entrez]
AID - 10.1177/070674370605101408 [doi]
PST - ppublish
SO  - Can J Psychiatry. 2006 Dec;51(14):923-9. doi: 10.1177/070674370605101408.