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Antidepressant Use and Incident Ischemic Heart Disease in Women Veterans With Posttraumatic Stress Disorder
Ebrahimi R, Alvarez C, Dennis P, Shroyer L, Yang H, Perkins A, Beckham J, Sumner J. Antidepressant Use and Incident Ischemic Heart Disease in Women Veterans With Posttraumatic Stress Disorder. [Abstract]. Circulation. 2022 Oct 30; 146(Suppl_1):A12063.
Introduction: Antidepressants, namely selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are efficacious in reducing posttraumatic stress disorder (PTSD) symptoms, but their implications for cardiovascular health are unclear. Although SSRI/SNRI treatment could improve PTSD-thus decreasing cardiovascular risk, antidepressant use has also predicted cardiovascular events. This study examined if antidepressant use was associated with developing ischemic heart disease (IHD) in women veterans with PTSD.
Methods: The Veterans Affairs (VA) electronic health record (EHR) database was used to identify women veterans with PTSD who engaged with VA healthcare from 2000-2019. Antidepressant use (documented in the EHR) was categorized as SSRIs, SNRIs, both SSRIs/SNRIs, other, or none (ref). We used Cox regression with time-varying exposure and covariates to estimate effects of antidepressants on risk of incident IHD (angina, MI, CAD). Once a woman was exposed to antidepressants, she was considered exposed until IHD onset or censoring. Age, race, ethnicity, and a range of time-varying risk factors [traditional risk factors (e.g., hypertension), other medical risk factors (e.g., obesity), women-specific risk factors (e.g., preeclampsia), psychiatric risk factors (e.g., depression)], were covariates.
Results: The analytic sample comprised 143,324 women without IHD at start of follow-up; mean age was 36.1 years (SD = 11.0). Over a median follow-up of 8.6 years, there were 6,633 incident IHD cases. When adjusting for demographics and traditional IHD risk factors, exposure to SNRIs was associated with a 33% greater rate of IHD (95% CI: 1.24-1.43), SSRIs with a 27% greater rate (95% CI: 1.20-1.34), both SSRIs/SNRIs with a 59% greater rate (95% CI: 1.01-2.49), and other antidepressants with a 24% greater rate (95% CI: 1.17-1.31). Associations with SNRIs (HR = 1.21, 95% CI: 1.12-1.30), SSRIs (HR = 1.15, 95% CI: 1.09-1.22), and other antidepressants (HR = 1.19, 95% CI: 1.13-1.26) remained significant in fully adjusted models.
Conclusions: Antidepressant use in women veterans with PTSD may exacerbate risk of IHD. Mechanism-focused research and further work in women veterans without PTSD is also needed.