Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Public Health, University of Helsinki, Helsinki, Finland.
Ann Med. 2022 Dec;54(1):1757-1766. doi: 10.1080/07853890.2022.2089729.
We examined the association between initiation of antidepressants within the first year after ischaemic stroke (IS) in young adults and long-term fatal and non-fatal cardiovascular events, as well as all-cause mortality.
The Helsinki Young Stroke Registry (HYSR) includes patients aged 15-49 years with their first-ever IS occurring 1994-2007. From nationwide registers, we obtained data on prescriptions (1993-2011) and outcomes of interest (1994-2011). Time of initiating post-stroke antidepressants (PSADs) was defined as time of the first filled prescription for antidepressants within the first year from IS. To account for non-random assignment of PSADs, we performed propensity score matching and studied the relationship between PSAD initiation and outcomes using Cox regression models with time-varying coefficients.
Of all patients ( = 888), 206 (23.2%) initiated PSADs within the first year, of which 203 (98.5%) could be matched to 406 non-initiators. In this matched sample of 609 patients, the median follow-up time was 8.1 (interquartile range [IQR] 5.0-12.6) years and 169 (28.9%) patients had any cardiovascular events, 95 (15.8%) had recurrent ischaemic or haemorrhagic strokes and 106 (17.4%) died. Adjusted for sociodemographics and cardiovascular comorbidities, PSAD initiation was associated with recurrent ischaemic or haemorrhagic stroke 5-10 years after IS (hazard ratio [HR] 3.07, 95% confidence interval [CI] 1.32-7.12). No association emerged between PSAD initiation and other outcomes.
In young adults, PSAD initiation within the first year after IS was associated with a heightened hazard of recurrent ischaemic or haemorrhagic stroke in the long term. Future studies are needed to verify the results and to further study the nature of this finding.KEY MESSAGESInitiation of post-stroke antidepressants (PSADs) within the first year after ischaemic stroke (IS) was associated with a heightened hazard of recurrent ischaemic or haemorrhagic stroke in the long term.Patients starting antidepressants after IS should be followed up more closely in case of recurrent events.Future studies are needed to verify the results and to further study the nature of this finding.
我们研究了年轻人缺血性中风（IS）后第一年开始使用抗抑郁药与长期致命和非致命心血管事件以及全因死亡率之间的关系。
赫尔辛基青年中风登记处（HYSR）包括 1994 年至 2007 年期间首次发生年龄在 15-49 岁的 IS 患者。我们从全国登记处获得了有关处方（1993-2011 年）和感兴趣结局（1994-2011 年）的数据。中风后开始使用抗抑郁药（PSADs）的时间定义为中风后第一年首次开具抗抑郁药处方的时间。为了说明 PSADs 的非随机分配，我们进行了倾向评分匹配，并使用时变系数 Cox 回归模型研究了 PSADs 起始与结局之间的关系。
在所有患者中（ = 888），206 例（23.2%）在第一年开始使用 PSADs，其中 203 例（98.5%）可以与 406 例非使用者匹配。在这 609 例匹配患者中，中位随访时间为 8.1 年（四分位距 [IQR] 5.0-12.6），169 例（28.9%）发生任何心血管事件，95 例（15.8%）发生复发性缺血性或出血性中风，106 例（17.4%）死亡。调整社会人口统计学和心血管合并症后，PSADs 起始与中风后 5-10 年发生复发性缺血性或出血性中风相关（风险比 [HR] 3.07，95%置信区间 [CI] 1.32-7.12）。PSADs 起始与其他结局之间无关联。
在年轻人中，IS 后第一年开始使用 PSADs 与长期复发性缺血性或出血性中风的风险增加相关。需要进一步的研究来验证这些结果，并进一步研究这一发现的性质。
IS 后第一年开始使用抗抑郁药与长期复发性缺血性或出血性中风的风险增加相关。开始使用抗抑郁药后应更密切地监测中风后患者，以防复发事件。需要进一步的研究来验证结果，并进一步研究这一发现的性质。
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