Use of tricyclics (HR 2.46), atypicals (HR 1.59), and SSRIs (HR 1.45) was associated with increased risk of major adverse cardiovascular events, whereas SNRIs (HR 0.89) showed no increased risk.
Cohort (n=1,694)
No
Does antidepressant use by class increase the risk of major adverse cardiovascular events in patients with coronary artery disease completing cardiac rehabilitation?
In patients with coronary artery disease completing cardiac rehabilitation, use of tricyclic, atypical, and SSRI antidepressants was associated with an increased risk of MACE, whereas SNRI use was not.
Effect estimate: HR 2.46 (95% CI 1.37-4.42)
BACKGROUND: To assess use of antidepressants by class in relation to cardiology practice recommendations, and the association of antidepressant use with the occurrence of major adverse cardiovascular events (MACE) including death. METHODS: This is a historical cohort study of all patients who completed cardiac rehabilitation (CR) between 2002 and 2012 in a major CR center. Participants completed the Patient Health Questionnaire (PHQ-9) at the start and end of the program. A linkage system enabled ascertainment of antidepressant use and MACE through 2014. RESULTS: There were 1,694 CR participants, 1,266 (74.7%) of whom completed the PHQ-9 after the program. Depressive symptoms decreased significantly from pre- (4.98 ± 5.20) to postprogram (3.57 ± 4.43) (p < 0.001). Overall, 433 (34.2%) participants were on antidepressants, most often selective serotonin reuptake inhibitors (SSRI; n = 299; 23.6%). The proportion of days covered was approximately 70% for all 4 major antidepressant classes; discontinuation rates ranged from 37.3% for tricyclics to 53.2% for serotonin-norepinephrine reuptake inhibitors (SNRI). Antidepressant use was significantly associated with lower depressive symptoms after CR (before, 7.33 ± 5.94 vs. after, 4.69 ± 4.87; p < 0.001). After a median follow-up of 4.7 years, 264 (20.9%) participants had a MACE. After propensity matching based on pre-CR depressive symptoms among other variables, participants taking tricyclics had significantly more MACE than those not taking tricyclics (HR = 2.46; 95% CI 1.37-4.42), as well as those taking atypicals versus not (HR = 1.59; 95% CI 1.05-2.41) and those on SSRI (HR = 1.45; 95% CI 1.07-1.97). There was no increased risk with use of SNRI (HR = 0.89; 95% CI 0.43-1.82). CONCLUSION: The use of antidepressants was associated with lower depression, but the use of all antidepressants except SNRI was associated with more adverse events.
Grace et al. (Mon,) conducted a cohort in Coronary Artery Disease (n=1,694). Antidepressants (tricyclics, atypicals, SSRI, SNRI) vs. Not taking the respective antidepressant class was evaluated on Major adverse cardiovascular events (MACE) including death (HR 2.46, 95% CI 1.37-4.42). Use of tricyclics (HR 2.46), atypicals (HR 1.59), and SSRIs (HR 1.45) was associated with increased risk of major adverse cardiovascular events, whereas SNRIs (HR 0.89) showed no increased risk.