Antidepressant Medication Prescription and Incident Cardiovascular Disease in Women Veterans.

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Clinical Psychiatry Pub Date : 2025-05-07 DOI:10.4088/JCP.24m15647

Jennifer A Sumner, Paul A Dennis, Carlos A Alvarez, Aaron Perkins, Jean C Beckham, Ramin Ebrahimi

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引用次数: 0

Abstract

Objective: Antidepressants are commonly prescribed, yet understanding of consequences for cardiovascular disease (CVD) risk is less well-developed. We examined associations of antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], other antidepressants) with incident CVD in women Veterans, a population with a high psychiatric and CVD risk burden.

Methods: Using Veterans Health Administration (VHA) electronic health records, we identified women Veterans who were VHA patients from January 1, 2000, to December 31, 2019. Exclusion criteria included <12 months of baseline data before index visit, prior CVD or antidepressant prescription, and no encounters after index visit. Antidepressant prescriptions were documented in pharmacy data. Our primary outcome was an incident CVD composite, comprising first-onset ischemic heart disease, stroke, atrial fibrillation/flutter, heart failure/ cardiomyopathy, and pulmonary hypertension based on diagnostic codes.

Results: Women Veterans (N = 609,546) had a mean age of 41.3 years. During mean follow-up of 8.8 years, 40.1% of women were prescribed SSRIs, 18.2% SNRIs, and 38.6% other antidepressants; 9.2% developed CVD. Marginal structural modeling was used to de-confound associations of antidepressants with incident CVD, accounting for demographics, VHA engagement, traditional CVD risk factors, and psychiatric disorders. SSRIs, SNRIs, and other antidepressants (vs no antidepressants) were associated with lower incidence of the CVD composite, as well as ischemic heart disease and stroke (relative risk: 0.27-0.76). Additionally, the inverse association between antidepressants and CVD was larger for women with major depressive disorder, posttraumatic stress disorder, and anxiety disorders.

Conclusion: As antidepressants are widely prescribed in the VHA and beyond, these results are encouraging for patients receiving this care.

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女性退伍军人抗抑郁药物处方与心血管疾病发生率

目的：抗抑郁药是常用的处方，但对心血管疾病（CVD）风险后果的了解尚不充分。我们研究了抗抑郁药物（选择性5 -羟色胺再摄取抑制剂（SSRIs）、5 -羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）和其他抗抑郁药物）与女性退伍军人（精神疾病和心血管疾病风险较高的人群）心血管疾病发生率的关系。方法：利用退伍军人健康管理局（VHA）的电子健康记录，对2000年1月1日至2019年12月31日期间罹患VHA的女性退伍军人进行鉴定。排除标准包括：结果：女性退伍军人（N = 609,546），平均年龄41.3岁。在平均8.8年的随访期间，40.1%的女性服用了ssri类药物，18.2%的女性服用了SNRIs类药物，38.6%的女性服用了其他抗抑郁药物；9.2%发生心血管疾病。边际结构模型用于消除抗抑郁药与CVD事件的关联，考虑到人口统计学、VHA参与、传统CVD危险因素和精神疾病。SSRIs、SNRIs和其他抗抑郁药（与无抗抑郁药相比）与CVD复合物以及缺血性心脏病和中风的发生率较低相关（相对风险：0.27-0.76）。此外，抗抑郁药与心血管疾病之间的负相关在患有重度抑郁症、创伤后应激障碍和焦虑症的女性中更为明显。结论：由于抗抑郁药在VHA和其他地方被广泛使用，这些结果对接受这种治疗的患者来说是令人鼓舞的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Psychiatry 医学-精神病学

CiteScore

7.40

自引率

1.90%

发文量

审稿时长

3-8 weeks

期刊介绍： For over 75 years, The Journal of Clinical Psychiatry has been a leading source of peer-reviewed articles offering the latest information on mental health topics to psychiatrists and other medical professionals.The Journal of Clinical Psychiatry is the leading psychiatric resource for clinical information and covers disorders including depression, bipolar disorder, schizophrenia, anxiety, addiction, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder while exploring the newest advances in diagnosis and treatment.