使用抗抑郁药 5-羟色胺能药物与心脏瓣膜病：在健康改进网络（THIN）数据库中的巢式病例对照研究。

Use of antidepressant serotoninergic medications and cardiac valvulopathy: a nested case-control study in the health improvement network (THIN) database.

机构信息

Department of Preclinical and Clinical Pharmacology 'Mario Aiazzi Mancini', University of Florence, Italy.

出版信息

Br J Clin Pharmacol. 2012 Sep;74(3):536-44. doi: 10.1111/j.1365-2125.2012.04224.x.

DOI:10.1111/j.1365-2125.2012.04224.x

PMID:22356433

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3477355/

Abstract

AIMS

To quantify the risk of cardiac valvulopathy (CV) associated with the use of antidepressant serotoninergic medications (SMs).

METHODS

We conducted a case-control study nested in a cohort of users of antidepressant SMs selected from The Health Improvement Network database. Patients who experienced a CV event during follow-up were cases. Cases were ascertained in a random sample of them. Up to 10 controls were matched to each case by sex, age, month and year of the study entry. Use of antidepressant SMs during follow-up was defined as current (the last prescription for antidepressant SMs occurred in the 2 months before the CV event), recent (in the 2-12 months before the CV event) and past (>12 months before the CV event). We fitted a conditional regression model to estimate the association between use of antidepressant SMs and the risk of CV by means of odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Sensitivity analyses were conducted to test the robustness of our results.

RESULTS

The study cohort included 752,945 subjects aged 18-89 years. Throughout follow-up, 1663 cases (incidence rate: 3.4 per 10,000 person-years) of CV were detected and were matched to 16,566 controls. The adjusted OR (95% CI) for current and recent users compared with past users of antidepressant SMs were 1.16 (0.96-1.40) and 1.06 (0.93-1.22), respectively. Consistent effect estimates were obtained when considering cumulative exposure to antidepressant SMs during follow-up.

CONCLUSIONS

These results would suggest that exposure to antidepressant SMs is not associated with an increased risk of CV.

摘要

目的

量化与使用抗抑郁药 5-羟色胺能药物（SM）相关的心脏瓣膜病（CV）风险。

方法

我们进行了一项病例对照研究，该研究嵌套在从健康改善网络数据库中选择的使用抗抑郁药 SM 的队列中。在随访期间发生 CV 事件的患者为病例。在他们的随机样本中确定了病例。每例病例匹配了多达 10 名对照，按性别、年龄、研究入组的月份和年份进行匹配。在随访期间使用抗抑郁药 SM 定义为当前（最后一次抗抑郁药 SM 处方发生在 CV 事件前 2 个月内）、近期（在 CV 事件前 2-12 个月内）和过去（CV 事件前>12 个月）。我们使用条件回归模型来估计使用抗抑郁药 SM 与 CV 风险之间的关联，使用比值比（OR）和相应的 95%置信区间（CI）。进行敏感性分析以测试我们结果的稳健性。

结果

研究队列包括 752,945 名 18-89 岁的受试者。在整个随访期间，检测到 1663 例（发生率：每 10,000 人年 3.4 例）CV 病例，并与 16,566 名对照相匹配。与过去使用抗抑郁药 SM 的患者相比，当前和近期使用者的调整后 OR（95%CI）分别为 1.16（0.96-1.40）和 1.06（0.93-1.22）。当考虑随访期间抗抑郁药 SM 暴露的累积量时，得到了一致的效应估计值。