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Symptoms of depression were associated with cardiac events
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Women with depression were at increased risk for morbidity due to coronary heart disease and sudden cardiac death, according to recent study findings.
The researchers examined data of women in the Nurses’ Health Study (n=63,469) with no prior heart disease or stroke during follow-up.
During 1992, 7.9% of women had Mental Health Index scores <53. In multivariate models from 1996 and on, the proxy variable for clinical depression was linked to sudden cardiac death with an HR of 2.33 (95% CI, 1.47-3.70). The HR for the association between antidepressant use and sudden cardiac death was 3.34 (95% CI, 2.03-5.50), according to the researchers.
The association between depressive symptoms and CHD was strongest for fatal CHD (HR=1.49; 95% CI, 1.11-2.00).
“Although antidepressant use might be a marker of worse depression, its specific association with sudden cardiac death merits further study,” the researchers wrote.
Whang W. J Am Coll Cardiol. 2009;53:950-958.
We should be careful as there are multiple possibilities for these results. The first is that there is a known association between CHD and depression, and the worse the depression, the stronger the association. Thus, if depression is a partial surrogate for CAD, one would expect more sudden death in that group. In addition, it is hard to know how comprehensive the medical information included was. Finally, one cannot exclude the possibility that selective serotonin-reuptake inhibitors increase sudden death. We did not see that in ENRICHD, and the SADHART trial results suggested safety despite less than ideal efficacy, but that possibility still cannot be excluded, especially given the complex pharmacokinetics of these agents. In addition, some antidepressants work on cathecholamines, some on serotonin and some on both; no differences were reported. For now, I agree with the editorial that the data suggest the safety of selective serotonin-reuptake inhibitors. I do not believe, however, we can be as sure for agents that work on catecholamines or on both substrates.
– Allan S. Jaffe, MD
Cardiology Today Editorial Board member