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Risk of major adverse cardiovascular events in treatment-resistant or severe depression

Adam Nygren1, Johan Reutfors1, Pär Karlsson1

  • 1Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.

Journal of Affective Disorders
|May 17, 2025
PubMed

Insights

Patients with treatment-resistant depression (TRD) or severe depression do not face a higher overall risk of major adverse cardiovascular events (MACE). However, younger individuals with severe depression and TRD patients experiencing cardiovascular death show increased MACE risk.

Area of Science:

  • Cardiology
  • Psychiatry
  • Public Health

Background:

  • Depression is a known risk factor for major adverse cardiovascular events (MACE).
  • The specific cardiovascular risk for patients with treatment-resistant depression (TRD) or severe depression remains unclear.
  • Understanding these risks is crucial for patient management and public health strategies.

Purpose of the Study:

  • To investigate the association between treatment-resistant depression (TRD) and severe depression with the risk of major adverse cardiovascular events (MACE).
  • To compare the MACE risk in patients with TRD and severe depression against matched control groups.
  • To identify specific cardiovascular outcomes and demographic groups at elevated risk.

Main Methods:

  • Utilized national Swedish registers to identify patients aged 18-75 with depressive episodes.
  • Matched patients with depression, TRD, and severe depression to respective control groups.
  • Calculated hazard ratios for MACE, adjusting for sociodemographic and clinical factors.

Main Results:

  • Identified 143,731 patients with depression, including 23,335 with TRD and 45,217 with severe depression.
  • Overall MACE risk was elevated in patients with depression (aHR 1.50) but not significantly higher in TRD (aHR 1.06) or severe depression (aHR 1.04) groups compared to controls.
  • TRD patients showed a higher risk of cardiovascular death (aHR 1.32), and young adults (18-29) with severe depression had a significantly elevated MACE risk (aHR 2.82).

Conclusions:

  • Patients with TRD or severe depression do not present an elevated overall risk for MACE compared to other depressed individuals.
  • A specific increased risk for cardiovascular death exists in TRD patients.
  • Younger adults with severe depression may face a heightened MACE risk, warranting further investigation and targeted interventions.
Abstract

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