Abstract P358: Association of Antidepressant Medication Type With the Incidence of Cardiovascular Disease in the Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background: Although antidepressant medications (ADM) are effective in treating depression, a well-established cardiovascular risk factor, they are associated with autonomic dysfunction, also linked to the future risk of cardiovascular disease (CVD). It is unclear if a certain type of ADM’s is associated with less CVD risk than others. We hypothesized that selective serotonin reuptake inhibitors (SSRI) are associated with reduced hazards of atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI) and ischemic stroke (IS) as compared to non-SSRI ADM’s. Methods: We studied 2027 participants from the Atherosclerosis Risk in Communities (ARIC) Study (mean age 63 ± 10 years; 29% men; 78% white) who self-reported ADM use during at least one of the five study visits (1987 through 2013). Participants were classified as SSRI users (47%) vs non-SSRI users (53%). Those who never used ADM’s were excluded due to the concern of unmeasured confounding by their underlying depression. CVD events were adjudicated based on hospital records, participant and physician interviews, and death certificates, using validated criteria. Cox regression adjusted for sociodemographic and clinical variables (sex, age, race, center, level of education, cigarette smoking, alcohol use, BMI, use of antihypertensive medications, diabetes, systolic blood pressure, diastolic blood pressure, aspirin, and calendar year of AD initiation) were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) of CVD by type of ADM. Results: Participants were followed up from ADM initiation up to 2016 for a median of 13.5 years. In this sample we identified a total of 329 AF events, 366 HF events, 198 MI events and 134 IS events. In multivariable Cox regression models, SSRI use was not significantly associated with hazards of AF, HF, MI and IS, when compared to non-SSRI ADMs (HR= 1.11, 95%CI 0.88-1.40 for AF; HR= 0.93, 95%CI 0.72-1.20 for HF; HR= 0.91, 95%CI, 0.65-1.27 for MI; and HR= 1.02, 95%CI 0.67-1.56 for IS). Conclusion: In a community-based sample of individuals using ADM’s, ADM class (SSRI vs non-SSRI) was not associated with significantly different risk of incident CVD. These results do not provide evidence supporting the use of a particular ADM over another in relation to CVD risk.