Relationship between antidepressant therapy and risk for cardiovascular events in patients with and without cardiovascular disease
journal contributionposted on 14.12.2017, 11:41 by Kim L. Lavoie, Nicola Paine, Roxanne Pelletier, Andre Arsenault, Jean G. Diodati, Tavis S. Campbell, Louise Pilote, Simon L. Bacon
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. Methods: 2385 consecutive patients presenting for myocardial perfusion exercise stress tests underwent a sociodemographic, medical, and psychiatric interview (PRIME-MD) and completed the Beck Depression Inventory (BDI). History of 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, non-fatal 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 (HR=0.697; 95%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.
Grant support from the Canadian Institutes of Health Research (CIHR: MOP 79445 and 89965, KLL & SLB) and the Heart and Stroke Foundation of Canada, salary awards from the Fonds de la recherche du Quebec - sante (FRQS: KLL & SLB) and CIHR (KLL & SLB); Postdoctoral fellowships from FRQS and CIHR (MFE 146764) (both NJP) and graduate scholarship support from the Social Sciences and Humanities Research Council, CIHR and FRQS (all RP).
- Sport, Exercise and Health Sciences