Smoller Jordan W, Allison Matthew, Cochrane Barbara B, Curb J David, Perlis Roy H, Robinson Jennifer G, Rosal Milagros C, Wenger Nanette K, Wassertheil-Smoller Sylvia
Department of Psychiatry, Massachusetts General Hospital, Boston, 02114, USA.
Arch Intern Med. 2009 Dec 14;169(22):2128-39. doi: 10.1001/archinternmed.2009.436.
Antidepressants are commonly prescribed medications, but their effect on cardiovascular morbidity and mortality remains unclear.
Prospective cohort study of 136 293 community-dwelling postmenopausal women in the Women's Health Initiative (WHI). Women taking no antidepressants at study entry and who had at least 1 follow-up visit were included. Cardiovascular morbidity and all-cause mortality for women with new antidepressant use at follow-up (n = 5496) were compared with those characteristics for women taking no antidepressants at follow-up (mean follow-up, 5.9 years).
Antidepressant use was not associated with coronary heart disease (CHD). Selective serotonin reuptake inhibitor (SSRI) use was associated with increased stroke risk (hazard ratio [HR],1.45, [95% CI, 1.08-1.97]) and all-cause mortality (HR,1.32 [95% CI, 1.10-1.59]). Annualized rates per 1000 person-years of stroke with no antidepressant use and SSRI use were 2.99 and 4.16, respectively, and death rates were 7.79 and 12.77. Tricyclic antidepressant (TCA) use was associated with increased risk of all-cause mortality (HR,1.67 [95% CI, 1.33-2.09]; annualized rate, 14.14 deaths per 1000 person-years). There were no significant differences between SSRI and TCA use in risk of any outcomes. In analyses by stroke type, SSRI use was associated with incident hemorrhagic stroke (HR, 2.12 [95% CI, 1.10-4.07]) and fatal stroke (HR, 2.10 [95% CI, 1.15-3.81]).
In postmenopausal women, there were no significant differences between SSRI and TCA use in risk of CHD, stroke, or mortality. Antidepressants were not associated with risk of CHD. Tricyclic antidepressants and SSRIs may be associated with increased risk of mortality, and SSRIs with increased risk of hemorrhagic and fatal stroke, although absolute event risks are low. These findings must be weighed against quality of life and established risks of cardiovascular disease and mortality associated with untreated depression.
抗抑郁药是常用药物，但其对心血管疾病发病率和死亡率的影响仍不明确。
对女性健康倡议（WHI）中136293名社区绝经后女性进行前瞻性队列研究。纳入研究开始时未服用抗抑郁药且至少有1次随访的女性。将随访期间开始使用新型抗抑郁药的女性（n = 5496）的心血管疾病发病率和全因死亡率与随访期间未服用抗抑郁药的女性的这些特征进行比较（平均随访时间为5.9年）。
使用抗抑郁药与冠心病（CHD）无关。使用选择性5-羟色胺再摄取抑制剂（SSRI）与中风风险增加（风险比[HR]，1.45，[95%置信区间，1.08 - 1.97]）和全因死亡率增加（HR，1.32 [95%置信区间，1.10 - 1.59]）相关。未使用抗抑郁药和使用SSRI的每1000人年中风年化率分别为2.99和4.16，死亡率分别为7.79和12.77。使用三环类抗抑郁药（TCA）与全因死亡率风险增加相关（HR，1.67 [95%置信区间，1.33 - 2.09]；年化率，每1000人年14.14例死亡）。在任何结局风险方面，使用SSRI和TCA之间无显著差异。在按中风类型进行的分析中，使用SSRI与出血性中风（HR，2.12 [95%置信区间，1.10 - 4.07]）和致命性中风（HR，2.10 [95%置信区间，1.15 - 3.81]）相关。
在绝经后女性中，使用SSRI和TCA在冠心病、中风或死亡率风险方面无显著差异。抗抑郁药与冠心病风险无关。三环类抗抑郁药和SSRI可能与死亡率风险增加相关，SSRI与出血性和致命性中风风险增加相关，尽管绝对事件风险较低。这些发现必须与生活质量以及与未治疗抑郁症相关的既定心血管疾病和死亡率风险相权衡。
