title: The association of antidepressant and statin use with death and incident cardiovascular disease varies by depression severity.
abstract: Depression has been reported to be associated with a greater risk of death and cardiovascular disease (CVD); however, the impact of antidepressants (ADM) on CVD risk remains controversial. Statin use is known to decrease CVD risk. Whether the use of these medications together affects CVD risk has not been studied. Patients (N = 26,828) completing the patient health questionnaire (PHQ-9), ≥40 years of age, without prior CVD, and no prior ADM use were studied. Depressive severity was categorized as none-mild (PHQ-9 score ≤14, n = 21,517) and moderate-severe (PHQ-9 score ≥15, n = 5311). Cox hazard regression was used to evaluate the association of no ADM/no statin use (n = 23,104 [86.1%]), ADM/no statin use (n = 877 [3.3%]), no ADM/statin use (n = 2627 [9.8%]), and ADM/statin use (n = 220 [.8%]) with major adverse cardiovascular events (MACE: death, CAD, stroke). Patients averaged 56 ± 12 years; 61% female. There were 1182 (4.4%) 3 year MACE events. The association of ADM and statin use with MACE varied by depressive symptom severity, with statin therapy associated with a decreased risk in the none-mild group (HR = .78, p = .007) and ADM in the moderate-high group (HR = 0.58, p = 0.02). Concomitant use of ADMs and statins did not appear to provide additive benefit.
authors.affiliation: a Intermountain Medical Center , Intermountain Heart Institute , Murray , UT , USA.
authors.forename: Heidi T
authors.initials: HT
authors.lastname: May
authors.affiliation: a Intermountain Medical Center , Intermountain Heart Institute , Murray , UT , USA.
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.affiliation: a Intermountain Medical Center , Intermountain Heart Institute , Murray , UT , USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Reiss-Brennan
authors.affiliation: a Intermountain Medical Center , Intermountain Heart Institute , Murray , UT , USA.|b Department of Medicine , University of Utah , Salt Lake City , UT , USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Knight
authors.affiliation: a Intermountain Medical Center , Intermountain Heart Institute , Murray , UT , USA.|b Department of Medicine , University of Utah , Salt Lake City , UT , USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.affiliation: a Intermountain Medical Center , Intermountain Heart Institute , Murray , UT , USA.|b Department of Medicine , University of Utah , Salt Lake City , UT , USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.affiliation: a Intermountain Medical Center , Intermountain Heart Institute , Murray , UT , USA.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Brunisholz
authors.affiliation: a Intermountain Medical Center , Intermountain Heart Institute , Murray , UT , USA.|b Department of Medicine , University of Utah , Salt Lake City , UT , USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000401:mortality*; D002423:Cause of Death; D003866:Depressive Disorder / Q000188:drug therapy* / Q000401:mortality*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D014589:Utah
chemical_list: D000928:Antidepressive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Depression; antidepressant medication; cardiovascular risk; statins