Association of Antidepressant Medication Type With the Incidence of Cardiovascular Disease in the ARIC Study

• Type of Material: Article
• Authors: Zakaria Almuwaqqat, Emory University; Maan Jokhadar, Emory University; Faye L. Norby, University of Minnesota; Pamela L. Lutsey, University of Minnesota; Wesley T. O'Neal, Emory University; Amanda Seyerle, University of North Carolina at Chapel Hill; Elsayed Z. Soliman, Wake Forest School of Medicine; Lin Y. Chen, University of Minnesota; J. Douglas Bremner, Emory University; Laura Vaccarino, Emory University; Amit Shah, Emory University; Alvaro Alonso, Emory University
• Language: English
• Date: 2019-06-04
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.119.012503
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 8
• Issue: 11
• Start Page: e012503
• End Page: e012503
• Grant/Funding Information: The ARIC (Atherosclerosis Risk in Communities) study was funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute; National Institutes of Health; and the Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, and HHSN268201700002I).; This work was supported by an American Heart Association grant 16EIA26410001 (Alonso) and by National Institutes of Health research grants to K24 MH076955 to Bremner and K24 HL077506 to Vaccarino.
• Keywords: atrial fibrillation; depression; antidepressant
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background The association of antidepressant medication type with the risk of cardiovascular disease ( CVD ) is unclear. We hypothesized that selective serotonin reuptake inhibitors ( SSRI s) are associated with lower risks of CVD events relative to tricyclics and other non- SSRI antidepressants. Methods and Results We studied 2027 participants from the ARIC (Atherosclerosis Risk in Communities) study (mean age 63±10 years; 29% men; 78% white) treated with antidepressants at some time between 1987 and 2013. Antidepressant usage was confirmed by participants bringing pill bottles to study visits. CVD events in the study sample were identified, including atrial fibrillation, heart failure, myocardial infarction, and ischemic stroke. Hazard ratios were used to compare CVD events adjusted for sociodemographic and clinical risk factors in SSRI s users (47%) versus non- SSRI users. Participants were followed from antidepressant initiation up to 2016 for a median of 13.5 years. We identified 332 atrial fibrillation, 365 heart failure, 174 myocardial infarction and 119 ischemic stroke events. CVD risk was similar for SSRI s and non- SSRI antidepressant users (hazard ratio, 1.10; 95% CI , 0.86-1.41 for atrial fibrillation; hazard ratio, 0.98; 95% CI, 0.77-1.25 for heart failure; hazard ratio, 0.91; 95% CI , 0.64-1.29 for myocardial infarction; and hazard ratio, 1.07; 95% CI , 0.70-1.63 for ischemic stroke). Conclusions SSRI use was not associated with reduced risk of incident CVD compared with non- SSRI antidepressant use. These results do not provide evidence supporting the use of SSRI s compared with tricyclics and other non- SSRI antidepressants in relation to CVD risk.