Details

Autor(en) / Beteiligte

• Garfield, Lauren D

Titel

Depression pharmacotherapy, comorbid anxiety and the incidence of cardiovascular outcomes in a V.A. population

Ort / Verlag

ProQuest Dissertations & Theses

Erscheinungsjahr

2011

Quelle

ProQuest Dissertations & Theses A&I

Beschreibungen/Notizen

• Depression and cardiovascular disease (CVD) are of importance to public health due to their prevalence and to the serious consequences they pose to individuals and society. These disorders are highly comorbid and there is sufficient evidence to conclude that depression is a risk factor for cardiovascular disease. What is less well-understood is the effect of treatment for depression, specifically antidepressant pharmacotherapy, on risk for incident cardiovascular disease and the role that comorbid anxiety disorders may play in the development of CVD. This dissertation investigated these gaps in the existing literature by performing several retrospective cohort studies using Veterans Administration (VA) administrative data in a cohort of depressed VA patients, free of CVD at baseline. The first study identified factors associated with receipt of guidelinebased antidepressant pharmacotherapy in veterans experiencing a recurrent episode of depression (n=26,770). Receiving adequate acute- or continuation-phase antidepressant pharmacotherapy was associated with female gender, diagnosis of substance abuse or dependence, nicotine dependence or diagnosis of panic disorder. In the second study, the association between antidepressant pharmacotherapy and incident myocardial infarction (MI) and all-cause mortality was investigated in depressed veterans (n=93,653). Those who received 12-weeks of continuous antidepressant pharmacotherapy had significantly reduced risk of incident MI (HR=0.48 SSRI; HR=0.35 SNRI; HR=0.39 TCA; HR=0.41 Other). Twelve continuous weeks of antidepressants was also associated with decreased risk of all-cause mortality (HR range 0.50-0.66) across all classes of antidepressants. In the third study, the independent association between anxiety disorders and incident heart failure (HF) was investigated in a cohort of veterans (n=353,900). In individual models for anxiety disorder unspecified, generalized anxiety disorder (GAD), panic disorder and post traumatic stress disorder (PTSD) adjusted only for age, all of the anxiety disorders were significantly associated with risk for incident HF (HR range 1.09-1.27). However, after adjusting for sociodemographics, healthcare utilization, CVD risk factors and treatment and antidepressant and anxiolytic use, the anxiety disorders were no longer significantly associated with incident HF. There is much work still to be done to understand depression, anxiety and CVD.