Abstract 15372: Selective Serotonin Reuptake Inhibitors in Patients With Depression and Coronary Heart Disease: A Meta-Analysis.
Background: The occurrence of depression in patients with coronary heart disease (CHD) substantially increases the likelihood of a poorer cardiovascular prognosis. Although antidepressants use in CHD patients is controversial. We carried out a meta-analysis to evaluate the health effects of SSRI versus placebo or no antidepressants in patients with CHD and depression.
Methods: Randomized controlled trials (RCTs) were searched in MEDLINE, EMBASE, PsycINFO, the Cochrane Controlled Clinical Trial Register and other trial registries, and references of relevant articles. The primary outcomes were readmission for CHD and all-cause mortality; the secondary outcome was the severity of depression symptoms.
Results: When only properly randomized trials were considered (patients n.=734), SSRIs patients showed no significant improvement in mortality or CHD readmission rates, as compared to controls. Two of the three RCTs showed RRs that were reduced, but not significant (p=0.24). Conversely, when all studies were considered, patients assuming SSRI showed a significantly lower rate of CHD readmissions during the follow-up as compared with controls (RR=0.63; 95% CI: 0.46–0.86). Similarly, when all studies that assessed all-cause mortality were combined, a significantly lower risk of death (RR=0.56; 95% CI: 0.35–0.88) was observed for SSRI patients, but this association was no longer significant when the two studies with incorrect randomization were excluded (p=0.26). Four studies compared the remission rate for depression in patients assuming SSRIs versus controls. No relevant differences emerged excluding the trial with incorrect randomization: compared with control, the assumption of SSRI determined a 35% increase in the rate of remissions during the follow-up (95% CI: 15%–60%), and such a difference was highly significant (p<0.001).
Conclusion: In patients with CHD and depression, SSRI medication reduce depression symptoms and may improve CHD prognosis. However, the evidence is scarce and future adequately powered trials are urgently needed.
- © 2010 by American Heart Association, Inc.