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

Almeida, Osvaldo P., Ford, Andrew H., Hankey, Graeme J., Golledge, Jonathan, Yeap, Bu B., and Flicker, Leon (2019) Depression, antidepressants and the risk of cardiovascular events and death in older men. Maturitas, 128. pp. 4-9.

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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.

Item ID: 60678
Item Type: Article (Research - C1)
ISSN: 1873-4111
Keywords: Depression, Depressive symptoms, Antidepressants, Stroke, Angina, Ischaemic heart disease, Mortality, Adverse effects, Interaction
Copyright Information: © 2019 Elsevier B.V. All rights reserved.
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC 279408, NHMRC 379600, NHMRC 403963, NHMRC 513823, NHMRC 540403, NHMRC 540504, NHMRC 540405, NHMRC 634492, NHMRC 1021416, NHMRC 1045710, NHMRC 1060557
Date Deposited: 23 Oct 2019 07:32
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110299 Cardiovascular Medicine and Haematology not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 100%
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