Comparative cardiovascular safety of selective serotonin reuptake inhibitors (SSRIs) among Chinese senile depression patients

Abstract

Background: Senile depression patients in China usually present with a higher risk of coronary heart disease that may trigger cardiac death. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed antidepressants in China; the cardiovascular safety of SSRIs when used in Chinese senile depression patients has not been evaluated. Methods: A network of meta-analysis was conducted to fill the objectives. PubMed, Embase databases, and 2 Chinese language electronic databases WANFANG and CNKI were searched for the related articles. The primary outcome of the present study was the number of cardiovascular reactions when each SSRI drug was used among senile depression patients in China. Odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were calculated within pairwise and network meta-analysis. Results: Fifteen trials were identified, including 1432 patients; the network meta-analysis showed that Chinese senile depression patients treated by Escitalopram were associated with a lower risk of cardiovascular reaction (CDR) than Paroxetine (ORs 0.37, 95% CI 0.14–0.37). Escitalopram also exhibited distinct advantages compared with other SSRIs. The rank of SSRIs with respect to cardiovascular safety was Escitalopram > Sertraline > Citalopram > Paroxetine > Fluoxetine, respectively. Conclusion: Escitalopram exhibited distinct advantages compared with other SSRIs, while Fluoxetine had the biggest cardiovascular reaction probability.

SSRIs as Risk Reduction for Cardiovascular Disease in Patients with Schizophrenia

“…Recent clinical data also indicates there are differences in the potential cardiovascular benefits offered by SSRIs. Escitalopram appears to be the most advantageous for cardiovascular safety in older individuals at risk of coronary heart disease, whereas fluoxetine provided little benefit if at all [32]. In this same study, sertraline, citalopram and paroxetine delivered better caridoprotection than fluoxetine but less than escitalopram [32].…”

“…Not surprisingly, several studies have tried to establish whether SSRIs can minimize the risk of cardiovascular events. The majority of these publications indicate that SSRIs are cardioprotective in patients with depression (For a review refer to [9] and a recent meta-analysis by [32]) but inconsistencies remain [9,33]. Variations in the cardioprotective effects of SSRIs could be related to differences in its mechanism of action.…”

Selective serotonin reuptake inhibitors and risk reduction for cardiovascular disease in patients with schizophrenia: A controversial but promising approach

“…Not surprisingly, several studies have tried to establish whether SSRIs can minimize the risk of CV events. The majority of these publications indicate that SSRIs are cardioprotective in patients with depression (For a review refer to Andrade et al [ 9 ] and a recent meta-analysis by Guo et al [ 32 ]) but inconsistencies remain[ 9 , 33 ]. Variations in the cardioprotective effects of SSRIs could be related to differences in its mechanism of action.…”

“…Recent clinical data also indicates there are differences in the potential CV benefits offered by SSRIs. Escitalopram appears to be the most advantageous for CV safety in older individuals at risk of coronary heart disease, whereas fluoxetine provided little benefit if at all[ 32 ]. In this same study, sertraline, citalopram and paroxetine delivered better caridoprotection than fluoxetine but less than escitalopram[ 32 ].…”

Escitalopram Ameliorates Cardiomyopathy in Type 2 Diabetic Rats via Modulation of Receptor for Advanced Glycation End Products and Its Downstream Signaling Cascades

“…Moreover, the use of escitalopram in diabetic and depressed patients was associated with a possible beneficial effect on glycemic control without inducing weight gain (Gehlawat et al, 2013). Escitalopram also exhibits distinct advantages in comparison to other SSRIs regarding its cardiovascular safety (Guo et al, 2019).…”