Relationship between antidepressant therapy and risk for cardiovascular events in patients with and without
Kim L Lavoie1, Nicola J Paine2, Roxanne Pelletier2
1Department of Psychology, University of Québec at Montréal.
Insights
Antidepressant medication may reduce the risk of major adverse cardiovascular events (MACE) in patients undergoing stress tests. This finding supports treating depression in cardiac patients to improve cardiovascular outcomes.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Research
Background:
- Depression is recognized as a cardiac risk factor by the American Heart Association, prompting screening recommendations.
- Controversy exists regarding the link between depression treatment and improved cardiovascular outcomes.
- The study investigates the association between antidepressant use and major adverse cardiovascular events (MACE) in patients referred for exercise stress tests.
Purpose of the Study:
- To prospectively assess the association between antidepressant medication and MACE.
- To evaluate the impact of depression treatment on cardiovascular event risk in patients undergoing stress testing.
Main Methods:
- 2,385 patients undergoing exercise stress tests were interviewed using the Primary Care Evaluation of Mental Disorders (PRIME-MD) and Beck Depression Inventory (BDI).
- Antidepressant use, cardiovascular disease (CVD) history were self-reported and verified.
- An 8.8-year follow-up obtained MACE data (cardiac mortality, myocardial infarction, revascularization, cerebrovascular events) from administrative databases.
Main Results:
- Antidepressant treatment was associated with a 30% reduced risk of MACE (HR = 0.697, p = .029).
- A significant 46% risk reduction in MACE was observed among patients without prior CVD (HR = 0.542, p = .043).
- In depressed patients, antidepressant use showed a trend towards reduced MACE risk (adjusted HR = 0.674, p = .07).
Conclusions:
- Antidepressants may offer a cardio-protective effect in patients undergoing stress testing, irrespective of CVD or depression status.
- Treating depression with antidepressants in this population is supported by findings to potentially lower MACE risk.
- Further research may elucidate the mechanisms behind the observed cardio-protective effects of antidepressants.
Objective:
The American Heart Association has endorsed depression as a cardiac risk factor and recommends screening as part of routine practice. This has been met with controversy due to inconsistencies in the data linking depression treatment to better cardiovascular outcomes. Our objective was to prospectively assess the association between depression treatment (defined as being prescribed antidepressant medication) and major adverse cardiovascular events (MACE) in patients referred for exercise stress tests.
Method:
Two thousand three hundred eighty-five consecutive patients presenting for myocardial perfusion exercise stress tests underwent a sociodemographic, medical, and psychiatric interview (Primary Care Evaluation of Mental Disorders [PRIME-MD]) and completed the Beck Depression Inventory (BDI). History of cardiovascular disease (CVD) and antidepressant use was self-reported and verified via chart review. Participants followed over an 8.8-year follow up, and information regarding MACE incidence (including cardiac mortality, nonfatal myocardial infarction, revascularization procedures, cerebrovascular events) was obtained from provincial administrative databases.
Results:
8% (n = 190) of the sample were taking antidepressants at baseline, 41% (n = 916) had a history of CVD, and 38.7% (n = 921) had depression according to the PRIME-MD or BDI. Antidepressant treatment was associated with a 30% reduced risk of MACE (Hazard ratio [HR] = 0.697; 95% confidence interval [CI] = [0.504, 0.964]; p = .029). A 46% reduction in risk was associated with antidepressant treatment among those without CVD (HR = 0.542; 95% CI [0.299, 0.981]; p = .043). In depressed patients, a 33% reduction in risk of MACE associated with antidepressant use was seen (adjusted HR = 0.674; 95% CI [0.440, 1.033]; p = .07).
Conclusions:
Antidepressants may be cardio-protective among patients presenting for stress testing independent of risk factors including CVD and depression. Results support treating depression with antidepressants in this population to reduce risk of MACE. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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