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Major Adverse Cardiovascular Events in Antidepressant Users Within Patients With Ischemic Heart Diseases: A
Jae Hyun Kim1, Yun-Kyoung Song, Ha Young Jang1
1From the College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul.
Insights
Antidepressant use did not increase major adverse cardiovascular events (MACEs) in patients with ischemic heart disease (IHD). However, high-dose selective serotonin reuptake inhibitors (SSRIs) were linked to a higher stroke risk, warranting careful monitoring.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Ischemic heart disease (IHD) patients with depression face cardiovascular risks.
- Evaluating antidepressant effects on major adverse cardiovascular events (MACEs) in IHD is crucial.
Purpose of the Study:
- To assess the association between antidepressant use and MACE development in patients with IHD.
- To identify specific antidepressant classes or dosages that may influence cardiovascular risk.
Main Methods:
- A cohort of patients with depression and IHD (2008-2012) was identified using national health insurance data.
- Propensity score-matched analysis and Cox regression estimated hazard ratios for MACEs over a median 4.2-year follow-up.
- MACE included myocardial infarction, stroke, and cardiovascular death.
Main Results:
- Antidepressant use showed no overall association with MACE incidence (adjusted HR, 1.00).
- Selective serotonin reuptake inhibitors (SSRIs) were associated with an increased stroke risk.
- Higher SSRI doses (≥1.0 DDD) correlated with a greater risk of stroke (adjusted HR, 1.14).
Conclusions:
- Antidepressants generally do not elevate MACE risk in IHD patients.
- High-dose SSRI use requires careful monitoring for potential stroke risk.
- Further research may explore nuanced cardiovascular effects of specific antidepressants.
Background:
To evaluate the effect of antidepressants on the development of major adverse cardiovascular events (MACEs) in patients with ischemic heart disease (IHD), we analyzed the association between antidepressant use and the risk of MACE development.
Methods:
Patients with depression and a history of IHD between 2008 and 2012 were identified by using the National Health Insurance Service database. A cohort was followed up for the development of MACE until the end of 2015. Hazard ratios (HRs) for myocardial infarction, stroke, and cardiovascular death were estimated by Cox proportional hazard regression in a propensity score-matched cohort.
Results:
Over a median 4.2 years of follow-up, 2943 MACE occurred in 18,981 antidepressant users. Use of antidepressants was not associated with the incidence of MACE when compared with antidepressant nonusers (adjusted HR, 1.00; 95% confidence interval, 0.95-1.05). Among the analyses according to different classes of antidepressants, the increased risk of stroke was only observed in the subgroup of selective serotonin reuptake inhibitor (SSRI) users. Dose-response findings reported greater risk in those with higher doses of use (SSRIs with ≥1.0 defined daily dose; adjusted HR, 1.14; 95% confidence interval, 1.06-1.23), whereas duration response does not support association.
Conclusions:
Compared with antidepressant nonusers, use of antidepressants was not associated with occurrence of MACEs in patients with depression and IHD. Although the overall effect of antidepressants on the risk of MACE was neutral, careful monitoring of MACE development is recommended in high-dose SSRI users.
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