Antidepressants, Statins Have Separate Impact on CV Mortality

Marlene Busko

March 09, 2015

SAN DIEGO, CA — Among nondepressed or mildly depressed primary-practice patients, statin use was tied to a lower risk of major adverse cardiac events (MACE) at 3 years; however, in outpatients with newly diagnosed moderate to severe depression, antidepressant therapy was tied to a lower risk of this outcome, according a new study[1].

"We hypothesized that taking both statins and antidepressants would reduce cardiovascular risk more than either medication alone," Dr Heidi Thomas May (Intermountain Medical Heart Institute, Murray, UT) told heartwire . "However, we did not find this. Instead we found that the effectiveness of antidepressants and statin therapy to reduce death and incident cardiovascular disease at 3 years varied by the severity of depressive symptoms."

May discussed these findings in a media briefing, and the study is scheduled for presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions.

This study reinforces the importance of treating depression, since it is linked with worse cardiovascular disease outcomes, she added. Thus, clinicians should assess patients for depression, "like any other cardiovascular risk factor such as high blood pressure and high cholesterol levels," May said.

May and colleagues studied 26 826 patients seen in more than 85 primary-care clinics in Utah who replied to a nine-item patient health questionnaire (PHQ-9). About one in five patients (5311 patients) had a PHQ-9 score of 15 or more and were classed as having moderate to severe depression, and the rest had a PHQ-9 score of 14 or less and were classed as having no or mild depression.

The patients were 40 or older, with an average age of 56, and 58% were female. They had no prior CVD and no prior antidepressant use.

Within 60 days of the survey, 9.9% of patients with moderate or severe depression and 2.6% of patients with mild depression were prescribed an antidepressant. A total of 11.2% of patients with at most mild depression and 8.3% of patients with moderate or severe depression were taking statins within 60 days of the survey.

There were 1182 (4.4%) MACE events in the 3-year follow-up.

Adjusted hazard ratios for 3-year MACE*

Treatment No to mild depressive symptoms Moderate to severe depressive symptoms
ADM, no statin vs no ADM, no statin 1.33 0.47
No ADM, statin vs no ADM, no statin 0.79 0.97
ADM, statin vs no ADM, no statin 0.75 0.83
Statin vs no statin 0.78 1.01
ADM vs no ADM 1.21 0.58
ADM=antidepressant medication
*Adjusted for age, sex, hypertension, hyperlipidemia, diabetes, smoking, renal failure, history of non-skin cancer, medications (ACE inhibitors, ARB, beta-blockers, calcium-channel blockers, diuretics)

Notably, among patients with moderate to severe depression, those who were receiving antidepressants but no statins had a 53% lower risk of death, coronary artery disease, or stroke during the 3-year follow-up vs those who were not taking either drug, May pointed out.

"Studies have shown that when people are depressed, they are less likely to practice good health habits, to take their full medical regimen," she said. Thus, when depressed people are being treated for depression, they may become more physically active, watch their diet, and be more compliant with medications such as antihypertensives, which would improve their heart health.

May reports no relevant financial relationships. Disclosures for the coauthors are linked to the abstract.


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