Antidepressants and the Risk of Cardiovascular Events in Elderly Affected by Cardiovascular Disease

Annalisa Biffi; Federico Rea; Lorenza Scotti; Ersilia Lucenteforte; Alfredo Vannacci; Niccolò Lombardi; Alessandro Chinellato; Graziano Onder; Cristiana Vitale; Silvia Cascini; Ylenia Ingrasciotta; Giuseppe Roberto; Alessandro Mugelli; Giovanni Corrao

doi:10.1097/jcp.0000000000001189

March 1, 2020Journal of Clinical Psychopharmacology

Antidepressants and the Risk of Cardiovascular Events in Elderly Affected by Cardiovascular Disease

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Why the study?

The study was conducted to evaluate the possible relationship between antidepressant drug use and the risk of hospitalization for cardiovascular events among older patients with prior cardiovascular disease.

Does the use of antidepressant drugs increase the risk of hospitalization for cardiovascular events in elderly patients with previous cardiovascular disease?

Structured PICO

Does the use of antidepressant drugs increase the risk of hospitalization for cardiovascular events in elderly patients with previous cardiovascular disease?

P

Population

344,747 individuals aged 65 years and older with previous cardiovascular disease (discharged for CV disease during 2008 to 2010), from 5 Italian health care territorial units. 97,739 cases experienced hospital admission for CV events.

I

Intervention

Current use of antidepressant drugs (tricyclic antidepressants, selective serotonin reuptake inhibitors [SSRIs], and atypical antidepressants)

C

Comparator

Non-use or past use of antidepressants (matched controls and within-patient case-crossover comparison)

O

Outcome

Hospitalization for cardiovascular events (composite of myocardial infarction, arrhythmia, stroke, heart failure) during follow-up until 2014composite

Current use of SSRIs and atypical antidepressants is associated with a significantly increased risk of cardiovascular events, including arrhythmia, stroke, and heart failure, in elderly patients with pre-existing cardiovascular disease.

Implication

Association warrants caution in elderly CV patients; leaves open causality and needs RCT confirmation.

Abstract

PURPOSE: The purpose of this study was to assess the possible relation between use of antidepressant (AD) drugs, that is, tricyclic ADs, selective serotonin reuptake inhibitors (SSRIs), and atypical ADs (AAs), and the risk of hospitalization for cardiovascular (CV) events among older patients with previous CV diseases. METHODS: A nested case-control study was carried out among patients aged 65 years and older from 5 Italian health care territorial units who were discharged for CV disease during 2008 to 2010. The cohort was composed by 344,747 individuals, and of these, 97,739 (28%) experienced hospital admission for CV events (myocardial infarction, arrhythmia, stroke, heart failure) during follow-up (until 2014) and were included as cases. Up to 5 controls were randomly selected and matched to each. A conditional logistic regression was fitted to estimate the risk of CV events associated with ADs past or current use. A within-patient comparison was performed by the case-crossover design to account the effect of depression. FINDINGS: Current users of SSRIs and AAs were at increased risk of CV events with odds ratios of 1.25 (95% confidence interval, 1.21-1.29) and 1.31 (1.25-1.37), respectively. An increased risk of arrhythmia and stroke was associated with current use of SSRIs and AAs, whereas an increased risk of heart failure was detected with current use of any ADs. The results were confirmed by the case-crossover approach. IMPLICATIONS: Evidence that AD use is associated with an increased risk of CV events in accordance with specific mechanisms of action among older people with CV disease was added by this study.