Key result
Clinical depression proxy linked to ~133% higher sudden cardiac death risk in cohort study.
Why the study?
Does clinical depression or antidepressant use increase the risk of sudden cardiac death and coronary heart disease in women without baseline CHD?
Cohort (n=63,469)
Does clinical depression or antidepressant use increase the risk of sudden cardiac death and coronary heart disease in women without baseline CHD?
Hazard Ratio: 2.33 (95% CI 1.47–3.7)
p-value: p=<0.001
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our study raises questions about the mechanism by which depression is associated with sudden cardiac death. This is not the first study to link risk of SCD to depression. Our study is consistent with prior analyses that have found an association between depressive symptoms and a higher mortality in patients with CHD, and it points to arrhythmia as a possible mechanism for this worse prognosis.”
“The absence of proof that antidepressants might cause cardiac events is more relevant than conclusive proof that this effect is absent. Nevertheless, these findings are sufficiently sobering to warrant heightened clinical surveillance and to initiate studies to definitively address this relationship.”
Clinical depression, and specifically antidepressant use, is associated with an increased risk of sudden cardiac death in women without prior cardiovascular disease.
Objectives We assessed the association between depression and sudden cardiac death (SCD) and cardiac events among individuals without baseline coronary heart disease (CHD). Background Depression is a risk factor for cardiac events and mortality among those with CHD, possibly from arrhythmia. Methods We studied depressive symptoms, and a proxy variable for clinical depression consisting of severe symptoms and/or antidepressant medication use, and their relationship to cardiac events in the Nurses’ Health Study. Questionnaires in 1992, 1996, and 2000 assessed symptoms with the Mental Health Index (MHI-5), and antidepressant use was assessed in 1996 and 2000. Primary endpoints included SCD, fatal CHD, and non-fatal myocardial infarction (MI). Results Among 63,469 women without prior CHD/stroke in 1992, 7.9% had MHI-5 scores (<53) previously found to predict clinical depression. Depressive symptoms were associated with CHD events, and the relationship was strongest for fatal CHD, where the association remained significant even after controlling for CHD risk factors (HR=1.49; 95% CI 1.11–2.00 for MHI-5 score<53). In models from 1996 onward, our proxy variable for clinical depression was most associated with SCD in multivariable models (HR=2.33, 95% CI 1.47–3.70), and this risk was primarily due to a specific relationship between antidepressant use and SCD (HR=3.34, 95% CI 2.03–5.50). Conclusions In this cohort of women without baseline CHD, depressive symptoms were associated with fatal CHD, and a measure of clinical depression including antidepressant use was specifically associated with SCD. Although antidepressant use may be a marker of worse depression, its specific association with SCD merits further study. CONDENSED ABSTRACT We prospectively analyzed the association between depression and cardiac events in the Nurses’ Health Study. Symptoms of depression as measured by Mental Health Index (MHI-5) score were directly associated with risk of CHD events, and the relationship was strongest for fatal CHD. A proxy variable for clinical depression comprised of MHI-5 score<53 or antidepressant use was strongly associated with sudden cardiac death (SCD), primarily due to a specific relationship between antidepressant use and SCD. Although antidepressant use may be a marker of worse depression, its specific association with SCD merits further study.
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Whang et al. (2009) conducted a cohort in Without baseline coronary heart disease (n=63,469). Clinical depression (MHI-5 score <53 or antidepressant use) vs. Absence of clinical depression was evaluated on Sudden cardiac death (SCD) (HR 2.33, 95% CI 1.47-3.70, p=<0.001). A proxy measure of clinical depression including antidepressant use was associated with a significantly increased risk of sudden cardiac death (HR 2.33).
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