Cardiovascular Prevention and Rehabilitation Program, University Health Network, University of Toronto, Toronto, Ontario, Canada.
School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
Psychother Psychosom. 2018;87(2):85-94. doi: 10.1159/000486794. Epub 2018 Mar 13.
To assess use of antidepressants by class in relation to cardiology practice recommendations, and the association of antidepressant use with the occurrence of major adverse cardiovascular events (MACE) including death.
This is a historical cohort study of all patients who completed cardiac rehabilitation (CR) between 2002 and 2012 in a major CR center. Participants completed the Patient Health Questionnaire (PHQ-9) at the start and end of the program. A linkage system enabled ascertainment of antidepressant use and MACE through 2014.
There were 1,694 CR participants, 1,266 (74.7%) of whom completed the PHQ-9 after the program. Depressive symptoms decreased significantly from pre- (4.98 ± 5.20) to postprogram (3.57 ± 4.43) (p < 0.001). Overall, 433 (34.2%) participants were on antidepressants, most often selective serotonin reuptake inhibitors (SSRI; n = 299; 23.6%). The proportion of days covered was approximately 70% for all 4 major antidepressant classes; discontinuation rates ranged from 37.3% for tricyclics to 53.2% for serotonin-norepinephrine reuptake inhibitors (SNRI). Antidepressant use was significantly associated with lower depressive symptoms after CR (before, 7.33 ± 5.94 vs. after, 4.69 ± 4.87; p < 0.001). After a median follow-up of 4.7 years, 264 (20.9%) participants had a MACE. After propensity matching based on pre-CR depressive symptoms among other variables, participants taking tricyclics had significantly more MACE than those not taking tricyclics (HR = 2.46; 95% CI 1.37-4.42), as well as those taking atypicals versus not (HR = 1.59; 95% CI 1.05-2.41) and those on SSRI (HR = 1.45; 95% CI 1.07-1.97). There was no increased risk with use of SNRI (HR = 0.89; 95% CI 0.43-1.82).
The use of antidepressants was associated with lower depression, but the use of all antidepressants except SNRI was associated with more adverse events.
评估抗抑郁药的使用与心脏病学实践建议相关，以及抗抑郁药的使用与主要不良心血管事件（MACE）的发生（包括死亡）的关联。
这是一项对 2002 年至 2012 年期间在一家主要心脏康复中心完成心脏康复的所有患者进行的历史队列研究。参与者在项目开始和结束时完成了患者健康问卷（PHQ-9）。一个链接系统能够通过 2014 年确定抗抑郁药的使用情况和 MACE。
共有 1694 名心脏康复参与者，其中 1266 名（74.7%）参与者在项目结束后完成了 PHQ-9。抑郁症状从治疗前（4.98±5.20）显著降低到治疗后（3.57±4.43）（p<0.001）。总体而言，433 名（34.2%）参与者服用了抗抑郁药，最常见的是选择性 5-羟色胺再摄取抑制剂（SSRIs；n=299；23.6%）。所有 4 种主要抗抑郁药类别的覆盖率约为 70%；三环类抗抑郁药的停药率为 37.3%，5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI）的停药率为 53.2%。抗抑郁药的使用与心脏康复后抑郁症状的降低显著相关（治疗前，7.33±5.94 与治疗后，4.69±4.87；p<0.001）。在中位随访 4.7 年后，264 名（20.9%）参与者发生了 MACE。在基于其他变量的治疗前抑郁症状进行倾向评分匹配后，服用三环类抗抑郁药的参与者发生 MACE 的风险显著高于未服用三环类抗抑郁药的参与者（HR=2.46；95%CI 1.37-4.42），以及服用非典型抗抑郁药的参与者（HR=1.59；95%CI 1.05-2.41）和服用 SSRIs 的参与者（HR=1.45；95%CI 1.07-1.97）。服用 SNRI 并没有增加风险（HR=0.89；95%CI 0.43-1.82）。
抗抑郁药的使用与较低的抑郁程度相关，但除 SNRI 以外的所有抗抑郁药的使用都与更多的不良事件相关。
