Antidepressant Use and the Risk of Major Adverse Cardiovascular Events in Patients Without Known Cardiovascular Disease: A Retrospective Cohort Study

Abstract

Aims: Conflicting data exist on whether an association exists between antidepressants and the risk of major adverse cardiovascular events (MACEs) in patients with depression. This may be due to the use of various study designs and residual or unmeasured confounding. We aimed to assess the association between antidepressant use and the risk of MACEs while considering various covariates, including severity of depression and the cardiovascular disease (CVD) risk score.Methods: Patients newly diagnosed with depression with no history of ischemic heart disease and stroke were followed-up from 2009 to 2015. We conducted Cox proportional hazard regression analysis to estimate hazard ratios (HRs) for each antidepressant for MACE risk.Result: We followed-up (median, 4.4 years) 31,830 matched patients with depression (15,915 antidepressant users and 15,915 non-users). In most patients (98.7%), low-dose tricyclic antidepressants (TCAs) were related with a significantly increased risk of MACEs [adjusted HR = 1.20, 95% confidence interval (CI) = 1.03–1.40]. Duration response relationship showed a gradually increasing HR from 1.15 (95% CI = 0.98–1.33; <30 days of use) to 1.84 (95% CI = 1.35–2.51; ≥365 days of use) (p for trend <0.01). High Korean atherosclerotic CVD risk score (≥7.5%) or unfavorable lifestyle factors (smoking, alcohol intake, and exercise) were significantly associated with MACEs.Conclusion: Even at low doses, TCA use was associated with MACEs during primary prevention. Longer duration of TCA use correlated with higher HR. Careful monitoring is needed with TCA use in patients with no known CVD history.

Norepinephrine reuptake inhibitors and risk of antihypertensive treatment intensification and major adverse cardiovascular events in patients with stable hypertension and depression

“…For example, our findings differ from an observational study conducted in patients with newly diagnosed depression which compared the risk of MACE between TCAs versus non‐users of antidepressants 7 . That study found the use of TCAs to be associated with a modestly increased risk of MACE (HR: 1.20 [95% CI: 1.03, 1.40]) 7 . Likewise, in another study of adults with obesity and depression, compared to non‐use of antidepressants, use of TCAs (HR: 1.26 [95% CI: 1.01, 1.58]) was associated with increased risk of cardiovascular events 8 .…”

Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects

“…Sex and age were assessed at index date. Arterial hypertension, dyslipidemia, chronic obstructive pulmonary disease (COPD) or asthma, diabetes, depression [ 20 , 21 ], and neoplasia were identified as comorbidities of interest at index date and within the previous year (see Table S1 for identification criteria).…”

Enfermedad cardiovascular aterosclerótica y sexualidad

“…Por el contrario, los antidepresivos tricíclicos (ADTs) se han relacionado con un efecto arritmogénico en pacientes con EAC o arritmias ventriculares, y también, se han asociado con aumento de los ECVs adversos mayores en pacientes con ECVA conocida de base, 7 incluso con dosis diarias definidas como bajas (dosis de amitriptilina menores a 37,5 mg/día, por ejemplo) y en aquellos sin ECVA. 8 Este efecto se puede explicar por la disminución de la variabilidad de la frecuencia cardiaca y prolongación del QT, que favorece la aparición de arritmias cardiacas (bloqueo de los canales iónicos de Na + , Ca 2+ , K + ). Estudios han demostrado que el uso de ADTs se hace en promedio por más de 365 días, y los ECVs adversos mayores aparecen a los 410 días en promedio.…”

“…Estudios han demostrado que el uso de ADTs se hace en promedio por más de 365 días, y los ECVs adversos mayores aparecen a los 410 días en promedio. 8 Un estudio de cohortes 7 evidenció que, en pacientes depresivos con EAC, el uso de ADTs, ISRSs, y antidepresivos atípicos (con excepción de los inhibidores de la recaptación de serotonina-norepinefrina), comparados con placebo, se asociaron con más ECVs adversos mayores. Llama la atención entonces como los ISRSs, siendo los más prescritos y de primera línea en ECV, no están exentos de desenlaces cardiovasculares, aunque se requiere mayor evidencia al respecto.…”

“…La depresión y la ansiedad hacen parte de las diez primeras causas de los AVADs, y ambas son prevalente en pacientes con ECVA. 5 Adicionalmente, estos trastornos mentales tienen impacto en la salud sexual, 6 y su tratamiento con medicamentos antidepresivos puede tener efectos negativos a nivel cardiovascular 7 8 . El uso de medicamentos antidepresivos como los antidepresivos tricíclicos tiene efectos a nivel cardiovascular y son de amplio uso en la población, lo que constituye una carga adicional para desenlaces cardiovasculares más allá de los FRCVs tradicionales.…”