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• W1966995477 abstract "Drs. Shimbo et al may have misinterpreted the results of our multivariate analysis. In each of the three models reported, a different antidepressant class was compared with no antidepressant use. The models, however, do not represent three strata of antidepressant use. The hazard ratio for heart disease that was reported for each model represents the independent association of prior heart disease with myocardial infarction after multivariate adjustment. The models give no information about risk “in patients with heart disease,” for which stratified analyses would have been necessary. As Shimbo et al note, we reported the stratified age- and sex-adjusted risk, which showed a significant association between use of tricyclic antidepressants and myocardial infarction, even among the small subset of patients with evidence of prior heart disease. We did not perform stratified analyses with the full multivariate model because we feared that the smaller numbers might not provide reliable results for the full set of covariates. However, to satisfy the concern of Shimbo et al, we now report that, with the full model for the stratum of those with prior heart disease (indicated by prescriptions), the hazard ratio for use of tricyclic antidepressants was 2.9 (95% confidence interval [CI]: 1.3 to 6.3) and the hazard ratio for the use of SSRIs was 1.0 (95% CI: 0.1 to 7.5). These results are very similar to the age- and sex-adjusted results that we reported in the article. Using the narrowly defined International Classification of Diseases (ICD)-9 codes 410.0 to 410.9 to designate myocardial infarction seemed to us an appropriately conservative approach given that the data were taken from administrative records. Sudden deaths were included in our reported results for all-cause mortality. However, it is possible that excluding them from analyses that used myocardial infarction as the outcome might have biased those results. Thus, we performed the analyses for myocardial infarction adding deaths from cardiac arrest (ICD-9 codes 427.5 and 427.9) and sudden death (codes 798.9 and 799.1). In the full model using this composite outcome, the hazard ratio for use of tricyclic antidepressants was 2.0 (95% CI: 1.3 to 3.2) and the hazard ratio for use of SSRIs was 0.7 (95% CI: 0.2 to 2.1). Adding all cardiovascular deaths to the outcome gave similar results. The lack of statistical significance for the association between the use of SSRIs and myocardial infarction limits what can be said about the safety of that class. We agree with Shimbo et al that, as we stated in our article, a long-term controlled trial is needed to evaluate the safety of both classes of these agents. Nonetheless, until such a trial is conducted, the association of excess risk of myocardial infarction and sudden deaths with the tricyclic class should be cause for concern, especially for patients with other cardiovascular risk factors." @default.
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• W1966995477 date "2000-07-01" @default.
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• W1966995477 title "Excess risk of MI in patients treated with antidepressant medications: The reply" @default.
• W1966995477 doi "https://doi.org/10.1016/s0002-9343(00)00549-0" @default.
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