Association of Antidepressant and Atypical Antipsychotic Use with Cardiovascular Events and Mortality in a Veteran Population

作者：Acharya Tushar; Acharya Sabeena; Tringali Steven; Huang Jian^*

来源：Pharmacotherapy, 2013, 33(10): 1053-1061.

DOI：10.1002/phar.1311

• antidepressant
• atypical antipsychotics
• cardiovascular
• mortality

Study ObjectivesTo determine the patterns of antidepressant and atypical antipsychotic use in a veteran population with depression, and to determine if an association exists between specific antidepressant classes and atypical antipsychotics and the occurrence of cardiovascular events and all-cause mortality.
DesignRetrospective, cross-sectional study.
SettingPrimary care clinic at a Veterans Affairs hospital.
PatientsA total of 1136 patients diagnosed with depression who were receiving antidepressant monotherapy (664 patients) or no antidepressant therapy (472 patients [controls]) between June 2009 and December 2010.
Measurements and Main ResultsData on patient demographics, disease diagnoses, laboratory data, and drug therapy profiles were collected through medical record review. Of the 1136 patients, the mean patient age was 61years, 90% were men, and 77% were smokers. Mean body mass index was 30.4kg/m(2), blood pressure 126/73mm Hg, hemoglobin A(1c) 6%, low-density lipoprotein cholesterol level 106.7mg/dl, and Framingham score 17. Patients receiving antidepressant monotherapy were grouped according to antidepressant class; selective serotonin reuptake inhibitors (SSRIs) were most common. Concomitant use of atypical antipsychotics was more common with the serotonin-norepinephrine reuptake inhibitor (venlafaxine), SSRI, and serotonin receptor antagonist (trazodone) classes (p=0.0067). After adjusting for demographics, concomitant drugs, and comorbidities, SSRI use was significantly associated with lower all-cause mortality (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.19-0.71, p=0.0028). Notably, noradrenergic and specific serotonergic antidepressant (mirtazapine) use was significantly associated with higher prevalence of heart failure (OR 3.26, 95% CI 1.029-10.38, p=0.0445). Use of atypical antipsychotics was significantly associated with a higher prevalence of cerebrovascular events (OR 2.23, 95% CI 1.29-3.83, p=0.0036) and all-cause mortality (OR 2.05, 95% CI 1.03-4.1, p=0.04).
ConclusionOur results favor treatment of depression with SSRIs among patients at increased cardiovascular risk due to the potential mortality benefit of this class of drugs. Atypical antipsychotics should be used with caution in the elderly population. Mirtazapine use in patients with heart failure and depression deserves further investigation.

• 出版日期2013-10