Abstract
AbstractBackgroundPrevious evidence on antidepressant medication and cardiovascular disease (CVD) among patients with posttraumatic stress disorder (PTSD) has been inconclusive. We estimated the association between antidepressant medication and CVD by applying a marginal structural model.MethodsWe analyzed medical utilization records of 27 170 people with PTSD without prior major cardiovascular events in the Korean National Health Insurance Database (NHID). PTSD and CVD were defined in accordance with the recorded ICD-10 diagnostic codes. We acquired information on antidepressant use from the NHID and categorized them by medication type. A composite major adverse cardiovascular events (MACE) outcome was defined as coronary artery disease with revascularization, ischaemic stroke, and/or haemorrhagic stroke. We used inverse probability of treatment weighting to estimate the parameters of a marginal structural discrete-time survival analysis regression model, comparing the resulting estimates to those derived from traditional time-fixed and time-varying Cox proportional hazards regression. We calculated cumulative daily defined doses to test for a dose–response relationship.ResultsPeople exposed to antidepressants showed a higher hazard of MACE [hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.18–1.53]. The estimated effects were strongest for selective serotonin reuptake inhibitors (HR 1.24, 95% CI 1.08–1.44) and TCAs (HR 1.33, 95% CI 1.13–1.56). Exposure to serotonin-norepinephrine reuptake inhibitors did not appear to increase the risk of MACE. People exposed to higher doses of antidepressants showed higher risk of MACE.ConclusionsIn a national cohort of people with PTSD, exposure to antidepressant medications increased the risk of MACE in a dose–response fashion.
Publisher
Cambridge University Press (CUP)
Subject
Psychiatry and Mental health,Applied Psychology
Reference56 articles.
1. Association of Posttraumatic Stress Disorder and Incident Ischemic Heart Disease in Women Veterans
2. The epidemiology of antidepressant prescriptions in South Korea from the viewpoint of medical providers: A nationwide register-based study;Kim;Korean Journal of Biological Psychiatry,2019
3. Ethnic differences in antidepressant response: a prospective multi-site clinical trial
4. Initiation of antidepressant medication and risk of incident stroke: using the Adult Changes in Thought cohort to address time-varying confounding
5. Ministry of the Interior and Safety. (2019). Statistics on Foreign Residents by Local Governments in 2018. Retrieved from https://www.mois.go.kr/frt/bbs/type001/commonSelectBoardArticle.do?bbsId=BBSMSTR_000000000014&nttId=73857#none.