Prompt antidepressant treatment swiftly chopped cardiovascular risk

Prompt, effective treatment for depression in the primary care setting appears to swiftly reduce the elevated cardiovascular risk known to be tied to the mood disorder, reported at the annual meeting of the American College of Cardiology.

“We know that depression is a risk factor for long-term adverse cardiovascular outcomes. Our study shows that it can also have immediate effects on someone’s cardiovascular health. A study highlights the importance of screening for depression in the primary care setting – and if someone’s depressed, they need to be treated, said a cardiovascular and genetic epidemiologist at Intermountain Medical Center in Murray, Utah.

An observational study of the electronic medical records of 7,559 Intermountain Healthcare patients over age 40 years who completed the Patient Health Questionnaire-9 depression screening tool during a visit to an Intermountain primary care clinic for any reason was presented. They completed another PHQ-9 score of 10 or more triggers implementation of a depression treatment pathway, the specifics of which vary depending upon the severity of symptoms.

 On the basis of their two PHQ-9 scores, all patients were classified into one of four groups: The “nondepressed” group of 3,286 patients had a score of 9 or less on both occasions; the “remained depressed” cohort of 1,987 patients scored 10 or more on both PHQ-9s; the “no longer depressed” group of 1,542 patients scored at least 10 but subsequently improved by at least five points to a score of nine or less; and the 735 patients in the “became depressed” group first scored 9 or less on the PHQ-9 but subsequently had at least a five-point increase to a score of 10 or more.

The subjects were then followed for major adverse cardiovascular events, or MACE – defined as a composite if death, diagnosis of coronary artery disease, acute MI, stroke, and heart failure hospitalization – for a median of 208 days after completing their second PHQ-9.

The MACE rate was 4.8 percent in the nondepressed group and similar at 4.6 percent in the “no longer depressed” group. Both groups fared significantly better than the “remained depressed” and “became depressed” groups, which had MACE rates of six percent and 6.4 percent respectively.

In a multivariate regression analysis adjusted for demographics, cardiovascular risk factors, prior disease diagnoses, medications, and other potential confounders, the “remained depressed” group was 33 percent more likely to experience a cardiovascular event than was the nondepressed group. The “became depressed” group had a 44 percent increase in risk, compared with the nondepressed individuals. In contrast, the MACE risk in patients in the “no longer depressed” group was not significantly different from that of patients who weren’t depressed at either time point. And the MACE risk of patients who became depressed during the course of the study was no different from that of patients who remained depressed at both time points.