Comparative cardiovascular safety of selective serotonin reuptake inhibitors (SSRIs) among Chinese senile depression patients: A network meta-analysis of randomized controlled trials

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.