Abstract 15515: Adverse Cardiovascular Effects of the Mood and Anxiety Disorders and Their Treatments on Heart Rate Variability. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): A Cross-Sectional Analysis of Baseline Characteristics
Background: The effects of the mood and anxiety disorders, and their treatments on vagally-mediated cardiovascular function remain unclear. Resting-state heart rate (HR) and its variability (HRV) are psychophysiological markers of the cholinergic anti-inflammatory pathway, mediated by the vagus nerve, which plays a major role in the regulation of cytokine activity. We hypothesised that HR will be increased and HRV, decreased in these disorders. We also sought to determine the impact of antidepressant treatments. We further examined the impact of additional confounding variables including age, sex, physical activity, metabolic syndrome and coronary heart disease on findings.
Methods: The ELSA-BRASIL cohort includes a total of 15,105 participants. The Clinical Interview Schedule - Revised was used to obtain diagnoses of mood and anxiety disorders. HR as well as the square root of the mean squared difference of successive NNs (RMSSD) and high frequency HRV - commonly employed and stable measures of HRV - were extracted from a 10-minute supine electrocardiogram recording for analysis.
Results: Patients with mood and anxiety disorders displayed elevated HR, although effect sizes were small (p<0.05, Cohen’s d=0.2). No decreases in HRV were observed. The older tricyclic (n: 141) antidepressant (TCA) medications (p<0.001, Cohen’s d=0.83) and the serotonin and noradrenaline reuptake inhibitors (SNRIs) (n=87) (p<0.001, Cohen’s d=0.75) adversely affected HR and HRV. The effects of the selective serotonin reuptake inhibitors were small (n=500) (p<0.05, Cohen’s d=0.29). Effects were retained after controlling for confounders. Discussion: The most striking effects were those of antidepressants on vagally-mediated cardiovascular function - particularly the TCAs and SNRIs - which may, in part, underpin the increased incidence of cardiovascular disease reported in patients with the mood and anxiety disorders.
- © 2013 by American Heart Association, Inc.