title: Antidepressant Medication Use and Its Association With Cardiovascular Disease and All-Cause Mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
abstract: BACKGROUND
  Mixed evidence suggests that second-generation antidepressants may increase the risk of cardiovascular and cerebrovascular events.
  
  
  OBJECTIVE
  To assess whether antidepressant use is associated with acute coronary heart disease (CHD), stroke, cardiovascular disease (CVD) death, and all-cause mortality.
  
  
  METHODS
  Secondary analyses of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study were conducted. Use of selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, bupropion, nefazodone, and trazodone was measured during the baseline (2003-2007) in-home visit. Outcomes of CHD, stroke, CVD death, and all-cause mortality were assessed every 6 months and adjudicated by medical record review. Cox proportional hazards time-to-event analysis followed patients until their first event on or before December 31, 2011, iteratively adjusting for covariates.
  
  
  RESULTS
  Among 29 616 participants, 3458 (11.7%) used an antidepressant of interest. Intermediate models adjusting for everything but physical and mental health found an increased risk of acute CHD (hazard ratio [HR] = 1.21; 95% CI = 1.04-1.41), stroke (HR = 1.28; 95% CI = 1.02-1.60), CVD death (HR = 1.29; 95% CI = 1.09-1.53), and all-cause mortality (HR = 1.27; 95% CI = 1.15-1.41) for antidepressant users. Risk estimates trended in this direction for all outcomes in the fully adjusted model but only remained statistically associated with increased risk of all-cause mortality (HR = 1.12; 95% CI = 1.01-1.24). This risk was attenuated in sensitivity analyses censoring follow-up time at 2 years (HR = 1.37; 95% CI = 1.11-1.68).
  
  
  CONCLUSIONS
  In fully adjusted models, antidepressant use was associated with a small increase in all-cause mortality.
authors.affiliation: Auburn University, Auburn, AL, USA rah0019@auburn.edu.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
authors.affiliation: University of Alabama Birmingham, Birmingham, AL, USA.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Khodneva
authors.affiliation: University of Alabama Birmingham, Birmingham, AL, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Glasser
authors.affiliation: Auburn University, Auburn, AL, USA.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Qian
authors.affiliation: University of Alabama Birmingham, Birmingham, AL, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Redmond
authors.affiliation: University of Alabama Birmingham, Birmingham, AL, USA.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: REGARDS; antidepressant; coronary heart disease; mortality; stroke