After detailed evaluation of the remaining 31 full-text articles, 17 were excluded due to nonantidepressant exposure and non-MI outcome [Figure 1]. Open in a separate window Figure 1 Flowchart representing the selection process of studies Study CharacteristicsFourteen relevant studies were identified, including five cohort and nine caseCcontrol studies involving more than 838,993 subjects and more than 85,941 MI cases.[7,10,11,12,13,14,15,16,17,18,19,20,21,22] Participants were followed up for 4C13 years and the studies were published between 1996 and 2011. Five cohort studies of antidepressants use and risk of MI were published between 2000 and 2011 which included more than 242,419 participants, followed up for 4C13 years, reporting 1,111 incident MI cases among 97,207 antidepressants users, and 1,558 incidents of MI cases among 88,784 nonantidepressants users.[7,12,19,20,21] Three studies[7,20,21] assessed MI diagnosis through the database, and two studies[12,19] assessed diagnosis through hospital chart review. increased risk of MI after excluding one outlier (RR = 1.36; 95% CI = 1.10C1.67; 0.01), but SSRIs showing no association (RR = 0.84; 95% CI = 0.57C1.22; = 0.35). Conclusions: We found evidence that the use of antidepressants was associated with elevated risk of MI. Further research is needed to identify the underlying biological mechanisms. and statistic, a 0.10 was considered statistically significant for heterogeneity; for 0.05 was considered statistically significant, except otherwise specified. All analyses were performed using comprehensive meta-analysis software. The primary outcome of this meta-analysis was reported as pooled RR with 95% CI of developing MI in antidepressants users. To assess link between individual Arbutin (Uva, p-Arbutin) classes of antidepressants like (i) TCAs use and risk of MI; (ii) SSRIs use and risk of MI; (iii) non-SSRIs use and risk of MI, we used the available data from studies which reported RR estimates for these particular associations. Subgroup analyses were performed according to (i) study design (cohort and caseCcontrol); and (ii) adjustment for other CVDs, to examine the impact of these factors on the association. We performed a one-way sensitivity analysis to evaluate the stability of our results. The scope of this analysis was to evaluate the influence of individual studies by estimating the average RR in the absence of each study. We also conducted a cumulative meta-analysis to examine the influence of a single study on the summary risk estimate by adding one study in each turn. The present work was performed as per the guidelines proposed by the meta-analysis of observational studies in epidemiology group[29] and preferred reporting items for systematic reviews and meta-analyses [Supplementary Arbutin (Uva, p-Arbutin) Material] Open in a separate window Results Search ResultsA total of 2,288 articles were identified during the initial search [Figure 1]. After reviewing the titles and abstracts of these articles, Arbutin (Uva, p-Arbutin) 2,257 were found to Rabbit Polyclonal to ROCK2 be ineligible as they were reviews, case reports, letters, editorials, and others which did not meet the inclusion criteria. After detailed evaluation of the remaining 31 full-text articles, 17 were excluded due to nonantidepressant exposure and non-MI outcome [Figure 1]. Open in a separate window Figure 1 Flowchart representing the selection process of studies Study CharacteristicsFourteen relevant studies were identified, including five cohort and nine caseCcontrol studies involving more than 838,993 subjects and more than 85,941 MI cases.[7,10,11,12,13,14,15,16,17,18,19,20,21,22] Participants were followed up for 4C13 years and the studies were published between 1996 and 2011. Five cohort studies of antidepressants use and risk of MI were published between 2000 and 2011 which included more than 242,419 participants, followed up for 4C13 years, reporting 1,111 incident MI cases among 97,207 antidepressants users, and 1,558 incidents of MI cases among 88,784 nonantidepressants users.[7,12,19,20,21] Three studies[7,20,21] assessed MI diagnosis through the database, and two studies[12,19] assessed diagnosis through hospital chart review. All studies were conducted in United States of America (USA), except one study in Europe.[20] Nine caseCcontrol studies have been published between 1996 and 2011.[10,11,13,14,15,16,17,18,22] These studies included more than 596,574 participants, conducted for 1C13 years, reporting a total of 9,741 antidepressants users among 83,266 MI cases and 42,648 antidepressants users among 513,308 controls. Antidepressants use was ascertained by the database in.