Depression, antidepressants and the risk of cardiovascular events and death in older men

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: It is uncertain whether depression and exposure to antidepressants increase the risk of cardiovascular events in later life. This study attempts to clarify whether the risk of cardiovascular events associated with exposure to antidepressant medications varies according to history of depression.

METHODS: Cohort study of 5522 Australian men aged 70-89 years living in the metropolitan region of Perth, Western Australia, who were followed for novel cardiovascular events over 12 years. Clinical diagnoses followed the International Classification of Diseases (ICD) codes for ischaemic heart disease, cerebrovascular events and depressive disorders. Participants self-reported their use of medications. Other study measures included age, schooling, smoking history and the following concurrent morbidities: diabetes, hypertension, cancer, dementia, and respiratory diseases, gastrointestinal and renal diseases.

RESULTS: 374 men (6.8%) had a recorded or current diagnosis of depression and 365 (6.6%) were using an antidepressant. Prevalent depression and antidepressant use were associated with increased mortality hazard, but not the interaction between them (hazard ratio, HR = 0.46, 95%CI = 0.33, 0.65). Depression (HR = 1.50, 95%CI = 1.21, 1.86) and antidepressants (HR = 1.52, 95%CI = 1.20, 1.93) were associated with an increased risk of cardiovascular events, but the interaction term was associated with decreased risk (HR = 0.51, 95%CI = 0.30, 0.87). All analyses were adjusted for other study measures.

DISCUSSION: Depression and antidepressant use were associated with an increase in the 12-year risk of cardiovascular events, while antidepressants were associated with a decrease in the risk of cardiovascular events among older men with depression, but not among those without. This suggests that the effect of this interaction on the risk of cardiovascular events may be driven by the ability of antidepressants to lead to clinical improvements in mood.

Original languageEnglish
Pages (from-to)4-9
Number of pages6
JournalMaturitas
Volume128
DOIs
Publication statusPublished - Oct 2019

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Antidepressive Agents
Depression
Hazards
Cerebrovascular Disorders
Pulmonary diseases
Western Australia
Aptitude
Gastrointestinal Diseases
International Classification of Diseases
Depressive Disorder
Medical problems
Myocardial Ischemia
Dementia
Cohort Studies
Smoking
History
Hypertension
Morbidity
Kidney
Mortality

Cite this

@article{8142269aa24d43799849c04e6e55a7e7,
title = "Depression, antidepressants and the risk of cardiovascular events and death in older men",
abstract = "INTRODUCTION: It is uncertain whether depression and exposure to antidepressants increase the risk of cardiovascular events in later life. This study attempts to clarify whether the risk of cardiovascular events associated with exposure to antidepressant medications varies according to history of depression.METHODS: Cohort study of 5522 Australian men aged 70-89 years living in the metropolitan region of Perth, Western Australia, who were followed for novel cardiovascular events over 12 years. Clinical diagnoses followed the International Classification of Diseases (ICD) codes for ischaemic heart disease, cerebrovascular events and depressive disorders. Participants self-reported their use of medications. Other study measures included age, schooling, smoking history and the following concurrent morbidities: diabetes, hypertension, cancer, dementia, and respiratory diseases, gastrointestinal and renal diseases.RESULTS: 374 men (6.8{\%}) had a recorded or current diagnosis of depression and 365 (6.6{\%}) were using an antidepressant. Prevalent depression and antidepressant use were associated with increased mortality hazard, but not the interaction between them (hazard ratio, HR = 0.46, 95{\%}CI = 0.33, 0.65). Depression (HR = 1.50, 95{\%}CI = 1.21, 1.86) and antidepressants (HR = 1.52, 95{\%}CI = 1.20, 1.93) were associated with an increased risk of cardiovascular events, but the interaction term was associated with decreased risk (HR = 0.51, 95{\%}CI = 0.30, 0.87). All analyses were adjusted for other study measures.DISCUSSION: Depression and antidepressant use were associated with an increase in the 12-year risk of cardiovascular events, while antidepressants were associated with a decrease in the risk of cardiovascular events among older men with depression, but not among those without. This suggests that the effect of this interaction on the risk of cardiovascular events may be driven by the ability of antidepressants to lead to clinical improvements in mood.",
keywords = "Adverse effects, Angina, Antidepressants, Depression, Depressive symptoms, Interaction, Ischaemic heart disease, Mortality, Stroke",
author = "Almeida, {Osvaldo P.} and Ford, {Andrew H.} and Hankey, {Graeme J.} and Jonathan Golledge and Yeap, {Bu B.} and Leon Flicker",
year = "2019",
month = "10",
doi = "10.1016/j.maturitas.2019.06.009",
language = "English",
volume = "128",
pages = "4--9",
journal = "Maturitas",
issn = "0378-5122",
publisher = "Elsevier",

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TY - JOUR

T1 - Depression, antidepressants and the risk of cardiovascular events and death in older men

AU - Almeida, Osvaldo P.

AU - Ford, Andrew H.

AU - Hankey, Graeme J.

AU - Golledge, Jonathan

AU - Yeap, Bu B.

AU - Flicker, Leon

PY - 2019/10

Y1 - 2019/10

N2 - INTRODUCTION: It is uncertain whether depression and exposure to antidepressants increase the risk of cardiovascular events in later life. This study attempts to clarify whether the risk of cardiovascular events associated with exposure to antidepressant medications varies according to history of depression.METHODS: Cohort study of 5522 Australian men aged 70-89 years living in the metropolitan region of Perth, Western Australia, who were followed for novel cardiovascular events over 12 years. Clinical diagnoses followed the International Classification of Diseases (ICD) codes for ischaemic heart disease, cerebrovascular events and depressive disorders. Participants self-reported their use of medications. Other study measures included age, schooling, smoking history and the following concurrent morbidities: diabetes, hypertension, cancer, dementia, and respiratory diseases, gastrointestinal and renal diseases.RESULTS: 374 men (6.8%) had a recorded or current diagnosis of depression and 365 (6.6%) were using an antidepressant. Prevalent depression and antidepressant use were associated with increased mortality hazard, but not the interaction between them (hazard ratio, HR = 0.46, 95%CI = 0.33, 0.65). Depression (HR = 1.50, 95%CI = 1.21, 1.86) and antidepressants (HR = 1.52, 95%CI = 1.20, 1.93) were associated with an increased risk of cardiovascular events, but the interaction term was associated with decreased risk (HR = 0.51, 95%CI = 0.30, 0.87). All analyses were adjusted for other study measures.DISCUSSION: Depression and antidepressant use were associated with an increase in the 12-year risk of cardiovascular events, while antidepressants were associated with a decrease in the risk of cardiovascular events among older men with depression, but not among those without. This suggests that the effect of this interaction on the risk of cardiovascular events may be driven by the ability of antidepressants to lead to clinical improvements in mood.

AB - INTRODUCTION: It is uncertain whether depression and exposure to antidepressants increase the risk of cardiovascular events in later life. This study attempts to clarify whether the risk of cardiovascular events associated with exposure to antidepressant medications varies according to history of depression.METHODS: Cohort study of 5522 Australian men aged 70-89 years living in the metropolitan region of Perth, Western Australia, who were followed for novel cardiovascular events over 12 years. Clinical diagnoses followed the International Classification of Diseases (ICD) codes for ischaemic heart disease, cerebrovascular events and depressive disorders. Participants self-reported their use of medications. Other study measures included age, schooling, smoking history and the following concurrent morbidities: diabetes, hypertension, cancer, dementia, and respiratory diseases, gastrointestinal and renal diseases.RESULTS: 374 men (6.8%) had a recorded or current diagnosis of depression and 365 (6.6%) were using an antidepressant. Prevalent depression and antidepressant use were associated with increased mortality hazard, but not the interaction between them (hazard ratio, HR = 0.46, 95%CI = 0.33, 0.65). Depression (HR = 1.50, 95%CI = 1.21, 1.86) and antidepressants (HR = 1.52, 95%CI = 1.20, 1.93) were associated with an increased risk of cardiovascular events, but the interaction term was associated with decreased risk (HR = 0.51, 95%CI = 0.30, 0.87). All analyses were adjusted for other study measures.DISCUSSION: Depression and antidepressant use were associated with an increase in the 12-year risk of cardiovascular events, while antidepressants were associated with a decrease in the risk of cardiovascular events among older men with depression, but not among those without. This suggests that the effect of this interaction on the risk of cardiovascular events may be driven by the ability of antidepressants to lead to clinical improvements in mood.

KW - Adverse effects

KW - Angina

KW - Antidepressants

KW - Depression

KW - Depressive symptoms

KW - Interaction

KW - Ischaemic heart disease

KW - Mortality

KW - Stroke

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U2 - 10.1016/j.maturitas.2019.06.009

DO - 10.1016/j.maturitas.2019.06.009

M3 - Article

VL - 128

SP - 4

EP - 9

JO - Maturitas

JF - Maturitas

SN - 0378-5122

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