Which antidepressants can reduce risk of acute myocardial infarction?

Current use of antidepressants interfering selectively with the reuptake of serotonin and those antagonizing the 5‐HT_2A receptor results in a reduced risk of acute myocardial infarction (AMI), a recent study has shown.

These antidepressants should be used by patients at cardiovascular risk, the authors suggested.

This nested case–control study used a primary care database over the period 2002–2015 to assess the association between antidepressants use and AMI risk. The authors identified AMI cases from a cohort of patients aged 40–99 years and randomly selected five controls per case, matched to patients for exact age, sex, and index data.

Categories for exposure to antidepressants were as follows: current, recent, past, and nonusers. Conditional logistic regression was used to examine the relationship between the current use of different antidepressants and AMI as compared to nonuse. Dose and durations effects were also explored.

Overall, 24,155 incident AMI cases and 120,775 controls were included. Current use of antidepressants as a group correlated with a decreased risk (adjusted odds ratio [AOR], 0.86, 95 percent confidence interval [CI], 0.81–0.91), but it was chiefly driven by selective serotonin reuptake inhibitors (AOR, 0.86, 95 percent CI, 0.81–0.93).

There was also a reduced AMI risk with the use of trazodone (AOR, 0.76, 95 percent CI, 0.64–0.91) and clomipramine (AOR, 0.62, 95 percent CI, 0.40–0.96). Of note, no significant effect was found with other antidepressant agents.

“A duration‐dependent effect was suggested for selective serotonin reuptake inhibitors, trazodone, and clomipramine, while there was no clear dose‐dependency,” the authors noted.