Abstract 12231: Antidepressant Use is Associated With Reduced Cardiovascular Reactivity and Myocardial Ischemia During Mental Stress
Background: Mental Stress Induced Myocardial Ischemia (MSI) portends a worse prognosis in patients with CAD. Exaggerated cardiovascular reactivity to mental stress has been suggested as a possible mechanism. Arguably, treatment of this phenomenon would reduce morbidity and mortality. Recent evidence suggests a beneficial effect of antidepressants on MSI.
Hypothesis: We conducted a retrospective study with the hypothesis that antidepressant use will be associated with blunted cardiovascular reactivity and hence lower prevalence of ischemia during mental stress in patients with stable CAD.
Methods: Patients with stable CAD (n= 544, 31% female) underwent a standardized mental stress test using a public speaking task. Myocardial perfusion imaging with 99m-Tc-sestamibi was used to assess myocardial ischemia. Hemodynamic reactivity was calculated as the increase in SBP, DBP and HR from resting to peak stress values. Current depressive symptoms were assessed using the Beck Depression Inventory-II. A multivariate analysis was performed adjusting for age, sex, conventional cardiac risk factors, history of depression, depressive symptoms, and medications.
Results: Overall, 95 (18%) patients developed MSI and 117 (22%) were on antidepressants. Patients who developed MSI had higher DBP (P= 0.005) and HR (P= 0.010) increase during mental stress. Patients taking antidepressants had similar baseline SBP and DBP, but higher baseline HR (P= 0.002). During mental stress, those taking antidepressants displayed a lower increase in SBP (P≤0.001), DBP (P≤0.001), and HR (P= 0.041). After adjusting for aforementioned confounders, antidepressant use remained associated with a lower SBP and DBP reactivity (Beta= -9.3, P≤0.001; Beta= -4.8, P=0.002, respectively). Finally, antidepressant use was associated with a lower risk of developing MSI after adjusting for the aforementioned factors (OR= 0.49, P= 0.042).
Conclusions: Antidepressant use is associated with a lower cardiovascular reactivity to mental stress in patients with stable CAD, independent of depression history or current depressive symptoms, possibly leading to a lower frequency of ischemia in this setting. Our findings support recent data showing a beneficial effect of antidepressants on MSI.
- © 2013 by American Heart Association, Inc.