Antidepressants improve CV risk in patients with moderate or severe depressive symptoms

Patients with moderate or severe depression treated with antidepressants had a lower risk for death, CAD and stroke compared with patients not treated with antidepressants and statins.

Furthermore, statin use alone or in combination with antidepressants was not associated with significant CV risk reduction in this population.

Researchers evaluated data from 26,828 patients at Intermountain Healthcare clinics who responded to a nine-question PHQ-9 questionnaire to determine depressive symptoms. All patients were aged 40 years or older and had no history of CVD or antidepressant use. Follow-up was at least 60 days.

The primary outcome was 3-year major adverse cardiac events, defined as all-cause mortality, CAD or stroke.

Overall, 21,517 patients had no or mild depression (PHQ-9 score ≤14) and 5,311 had moderate or severe depression (PHQ-9 score ≥15).

Most patients (83.8%) with moderate or severe depression were receiving neither antidepressants nor statins, 6.2% statins but no antidepressants, 8% antidepressants but no statins, and 2% both antidepressants and statins. Statin use was more common in patients with no or mild depressive symptoms (11.2% vs. 8.3%). Patients with moderate or severe symptoms were more frequently treated with antidepressants (9.9% vs. 2.6%) and were also more likely to receive concomitant statin and antidepressant therapy (2% vs. 0.6%) compared with patients with no or mild symptoms.

Among patients with no or mild depressive symptoms, risk for MACE at 3 years was higher for those who received antidepressants but not statins (HR = 1.33 vs. nonrecipients of both medications) and lower among those who received statins alone (HR = 0.79) or both statins and antidepressants (HR = 0.75). The reduction in risk associated with statin use was observed regardless of antidepressant use (HR = 0.78).

Heidi T. May

Among patients with moderate or severe depression, those who received antidepressants but not statins had a significantly lower risk for MACE at 3 years compared with patients who received neither medication (HR = 0.47). Risk was also lower among those treated with both antidepressants and statins (HR = 0.83), and among those who received antidepressants compared with nonrecipients regardless of statin use (HR = 0.58). The observed associations in both groups were independent of age, sex and CV risk factors.

“Antidepressant and statin use differed in their association with 3-year MACE risk based on depressive symptoms among patients without CVD,” Heidi T. May, PhD, MSPH, FACC, cardiovascular epidemiologist at the Intermountain Medical Center Heart Institute in Salt Lake City, said during a press briefing held prior to the American College of Cardiology Scientific Sessions. “We found that concomitant use of statins and antidepressants did not result in an additive benefit or harm for 3-year MACE risk in both groups.”

Full results of this study will be presented during the ACC Scientific Sessions. The Cardiology Today, Cardiology Today’s Intervention and Healio.com/Cardiology team will provide live coverage of the conference from San Diego. Visit Healio.com/Cardiology throughout the meeting and beyond for more breaking news, video interviews and more. – by Adam Taliercio

For more information:

May HT, et al. Abstract 1178-111. Presented at: American College of Cardiology Scientific Session & Expo; March 14-16, 2015; San Diego.

Disclosure: May reports relevant financial disclosures.

Editor’s note: On March 27, this article was updated to incorporate new data on the number of patients who were receiving statins but no antidepressants, antidepressants but no statins and both antidepressants and statins.