Antidepressants as risk factor for ischaemic heart disease: case-control study in primary care

Objectives To determine whether antidepressants are a risk factor for ischa emic heart disease and tp compare the risk for different subgroups of antid epressants and individual antidepressants. Design Case-control study. Setting Nine general practices recruited from the Trent Focus Collaborative Research Network, Participants 933 men and women with ischaemic heart disease matched by age, sex, and practice to 5516 controls. Main outcome measure Adjusted odds ratio for ischaemic heart disease calcul ated by logistic regression. Results Odds ratios for ischaemic heart disease were significantly raised f or patients who had ever received a prescription for tricyclic antidepressa nts even after diabetes, hypertension, smoking, body mass index, and use of selective serotonin reuptake inhibitors had been adjusted for (1.56; 95% c onfidence interval 1.18 to 2.05). Patients who had ever taken dosulepin (do thiepin) had a significantly raised odds ratio for ischaemic heart disease after adjustment for confounding factors and use of other antidepressants ( 1.67, 1.17 to 2.36), There was no significant increase in the odds ratios f or amitriptyline, lofepramine, and selective serotonin reuptake inhibitors in multivariate analysis. Increasing maximum doses of dosulepin were associ ated with increasing odds ratios for ischaemic heart disease. Similarly, th ere was a significant positive trend associated with increasing numbers of prescriptions of dosulepin (adjusted odds ratio 1.52 for 1 prescription, 1. 39 for 2-3, and 1.96 for greater than or equal to4,P<0.002). Conclusion There is good evidence for an association between dosulepin and subsequent ischaemic heart disease and for a dose-response relation.