We identified four to six controls, matched for age and sex, for each case. been adjusted for (1.56; 95% confidence interval 1.18 to 2.05). Patients who had ever taken dosulepin (dothiepin) 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 for amitriptyline, lofepramine, and selective serotonin reuptake inhibitors in multivariate analysis. Increasing maximum doses of dosulepin were associated with increasing odds ratios for ischaemic heart disease. Similarly, there 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 Tafluprost for ?4, P 0.002). Conclusion There is good evidence for an association between dosulepin and subsequent ischaemic heart disease and for a dose-response relation. What is already known on this topic Over 45% of patients in hospital after myocardial infarction have depression Depression is an impartial risk factor for increased mortality and morbidity after myocardial infarction What this study adds Patients who had ever taken dosulepin (dothiepin) had significantly increased risk of ischaemic heart disease after confounding factors had been adjusted for The association followed a dose-response relation The effect of other antidepressants was not significant after adjustment for confounders Introduction Major depression is the fourth most important contributor to disability adjusted life years worldwide.1 Over 45% of patients in hospital after a myocardial infarction have depression,2 and it is an independent risk factor for increased mortality3 and morbidity4 after myocardial infarction. In 1998, we reported evidence for depression as a risk factor for ischaemic heart disease in men from a study conducted in a single practice.5 This association may have been related to use of antidepressant drugs, although our sample was too small to be certain. Tricyclic antidepressants are not recommended in patients with known ischaemic heart disease,6 mainly because of their arrhythmogenic activity.7 However, their potential role in the aetiology of ischaemic heart disease is unclear.8C10 A case-control study of fatal myocardial infarction in young women found an odds ratio of 16.9 for the use of psychotropic drugs.8 Conversely, a cohort study found that the association between ischaemic heart disease and tricyclic antidepressants probably reflected a primary relation between depressive disorder and ischaemic heart disease.9 Another study associated tricyclic antidepressants with increased risk of myocardial infarction, although it did not distinguish between drugs individually and those in combination, and it focused on myocardial infarction rather than on first presentation of ischaemic heart disease.11 We aimed to determine whether antidepressants are a risk factor for ischaemic heart disease and compare the risk for different subgroups of antidepressants and individual antidepressants. Participants and methods We recruited nine general practices from the Trent Focus Collaborative Research Network, which has been shown to be representative of other practices in Trent (unpublished data). Practices met minimum criteria for data quality: these were minimum levels of recording of nine chronic diseases (for example, prevalences of 4.3% for ischaemic heart disease, 2.7% for diabetes, and 10.3% for hypertension)12; lifestyle data and blood pressure recorded in more than 50% of adults; and use of practice computer for prescribing. The study was approved by Trent multicentre research ethics committee and local research ethics committee. This was a matched case-control study. We identified incident cases from the practice computer records for 1 January 1995 to 31 December 1999. Cases were men and women who had a recorded diagnosis of ischaemic heart disease (including angina, myocardial infarction, and coronary artery surgery) or were receiving repeat prescriptions for nitrates.13 We included only cases who had been registered with the practice for more than five years before ischaemic heart disease was diagnosed and whose first recorded diagnosis was at least five years after the date on which the practice had its current computer installed. Controls were patients Tafluprost who had never had a recorded diagnosis of ischaemic heart disease. We determined 4-6 controls, matched up for age group and sex, for every case. Controls had been selected by locating the individuals Tafluprost closest in age group (years) from an purchased list of individuals currently authorized using the same practice. Each control was assigned to only 1 case. Settings needed to be registered and alive using the.This persisted despite adjustments for confounding by diabetes, hypertension, smoking cigarettes, and body mass index (adjusted odds ratio 1.63, 1.28 to 2.08). Patients who was simply Tafluprost prescribed selective serotonin reuptake inhibitors had a significantly increased chances percentage for ischaemic cardiovascular disease on univariate evaluation (1.55, 1.18 to 2.01). chances ratios for ischaemic cardiovascular disease. Similarly, there is a substantial positive trend connected with more and more prescriptions of dosulepin (modified odds percentage 1.52 for 1 prescription, 1.39 for 2-3, and 1.96 for ?4, P 0.002). Summary There is great evidence for a link between dosulepin and following ischaemic cardiovascular disease as well as for a dose-response connection. What is currently known upon this subject Over 45% of individuals in medical center after myocardial infarction possess depression Depression can be an 3rd party risk element for improved mortality and morbidity after myocardial infarction What this research adds Individuals who got ever used dosulepin (dothiepin) got significantly increased threat of ischaemic cardiovascular disease after confounding elements had been modified for The association adopted a dose-response connection The result of additional antidepressants had not been significant after modification for confounders Intro Major depression may be the fourth most significant contributor to impairment modified life years world-wide.1 More than 45% of individuals in medical center after a myocardial infarction have depression,2 which is an unbiased risk element for increased mortality3 and morbidity4 after myocardial infarction. In 1998, we reported proof for depression like a risk element for ischaemic cardiovascular disease in males from a report conducted in one practice.5 This association might have been related to usage of antidepressant medicines, although our sample was too little to be sure. Tricyclic antidepressants aren’t recommended in individuals with known ischaemic cardiovascular disease,6 due to the fact of their arrhythmogenic activity.7 However, their potential part in the aetiology of ischaemic cardiovascular disease is unclear.8C10 A case-control research of fatal myocardial infarction in young women found an odds ratio of 16.9 for the usage of psychotropic medicines.8 Conversely, a cohort research discovered that the association between ischaemic cardiovascular disease and tricyclic antidepressants probably shown a primary connection between melancholy and ischaemic cardiovascular disease.9 Another research associated tricyclic antidepressants with an increase of threat of myocardial infarction, though it did not differentiate between drugs individually and the ones in combination, and it centered on myocardial infarction instead of on first presentation of ischaemic cardiovascular disease.11 We aimed to determine whether antidepressants certainly are a risk element for ischaemic cardiovascular disease and review the chance for different subgroups of antidepressants and individual antidepressants. Individuals and strategies We recruited nine general methods through the Trent Concentrate Collaborative Study Network, which includes been shown to become representative of additional methods in Trent (unpublished data). Methods met minimum requirements for data quality: they were minimum degrees Rabbit Polyclonal to BAD of documenting of nine persistent diseases (for instance, prevalences of 4.3% for ischaemic cardiovascular disease, 2.7% for diabetes, and 10.3% for hypertension)12; life-style data and blood circulation pressure documented in a lot more than Tafluprost 50% of adults; and usage of practice pc for prescribing. The analysis was authorized by Trent multicentre study ethics committee and regional study ethics committee. This is a matched up case-control research. We determined incident instances through the practice pc information for 1 January 1995 to 31 Dec 1999. Cases had been women and men who got a documented analysis of ischaemic cardiovascular disease (including angina, myocardial infarction, and coronary artery medical procedures) or had been receiving do it again prescriptions for nitrates.13 We included just instances who was simply authorized using the practice for a lot more than five years before ischaemic cardiovascular disease was diagnosed and whose 1st recorded analysis was at least five years following the day which the practice got its current computer installed. Settings were individuals who got never really had a documented analysis of ischaemic cardiovascular disease. We determined 4-6 controls, matched up for age group and sex, for every case. Controls had been selected by locating the individuals closest in age group (years) from an purchased list of individuals currently authorized using the same practice. Each control was assigned to only 1 case. Controls needed to be alive and authorized using the same practice for the day that their matched up case was identified as having ischaemic cardiovascular disease as well as for the five years before this. Data collection We extracted computerised data for instances and controls prior to the day of analysis (or analysis of matched up case) using MIQUEST.14 The.