Mestrado em Saúde Pública / Master Degree Course in Public Health / Abstract
Depression and cardiovascular disease: a pharmacoepidemiologic perspective
by
Germano Leonel Coelho Ferreira
Supervisor: Professor Doutor Henrique de Barros
Serviço de Higiene e Epidemiologia
da Faculdade de Medicina da Universidade do Porto.
Depressive disorder and cardiovascular disease comprise the two health conditions
with higher burden in public health. It is known that individuals suffering from
chronic illness are more likely to suffer psychological disturbances. In both cases
treatment relies mostly on pharmacological interventions. Neuro-physiological and
psychosocial links have been proposed to explain the interaction between depression
and cardiovascular conditions.
Our aim was to study the association between depression and cardiovascular disease
from a pharmacoepidemiologic perspective, namely the likelihood for the treatment of
depression to be associated with the treatment of cardiovascular disease, and the
factors affecting this association.
The study was comprised of two stages: a) a systematic review of available literature
on the association of antidepressant drugs use with cardiovascular therapy; b) a crosssectional
study where treatment with antidepressant drugs was considered the
outcome of interest, evaluating the effect of selected determinants including
concomitant use of cardiovascular treatment.
The systematic literature review consisted of a search on MEDLINE, EMBASE and
PsycINFO databases using pre-specified keywords. 4 publications were included in
the review out of 1008 citations initially retrieved. The published evidence reveals a
small number of studies and inconclusive results. Predominantly the authors suggest a
strong influence by factors, such as gender and intensity of contact with the healthcare
system.
A cross-sectional study was conducted based on self-reported information on drug
use, collected through interviews from a cohort of adults residents the city of Porto,
Portugal. The data about the drugs used regularly in the year previous to the interview
were then coded and classified according to the ATC classification system. Gender,
age, marital status, educational attainment, employment situation and medical history
were also collected. Of the 1852 individuals participating in the study, 1016
completed the Beck Depression Inventory and were asked the number of medical
visits during the preceding 12 months.
In the complete cohort, the prevalence of antidepressants use was 7.0% (95%CI: 5.8,
8.2) and depression was reported by 4.3% (95%CI: 3.4, 5.3) of the participants.
Although antidepressant use was associated with female gender, some age strata,
divorced/widowed marital status and cardiovascular drug use in the univariate
analysis, after adjusting for demographic and social factors, using unconditional
logistic regression, the association with cardiovascular drug use dissipated. The only
factors remaining positive were female gender and self-reported depression.
In a second analysis, those participants with a BDI 10 or had reported using at least
one antidepressant drug, were classified as depressed and were included in the subanalysis
to assess the likelihood of antidepressant use among depressed patients
adjusting for age and gender together with number of medical visits and
cardiovascular drug use. Female gender (OR=2.72; 95%CI: 1.20, 6.15) and a greater
number of medical visits in the previous year [OR=3.88 (95%CI: 1.55, 9.75) for 2-5
visits, and OR=11.40 (95%CI: 3.92, 33.14) for 6-11 visits, compared to 0-1 visits] had
a statistically significant association with antidepressant use in patients classified as
depressed.
The results of this study are in line with the results from previous research and allow
us to conclude that the use of antidepressants is not likely to be associated with
concomitant use of cardiovascular therapies. The apparent association may be the
result of parallel chronic conditions and intense contact with the health care system
| Identifer | oai:union.ndltd.org:up.pt/oai:repositorio-aberto.up.pt:10216/22229 |
| Date | 27 July 2007 |
| Creators | Ferreira, Germano Leonel Coelho |
| Publisher | Faculdade de Medicina da Universidade do Porto, FMUP |
| Source Sets | Universidade do Porto |
| Language | Portuguese |
| Detected Language | English |
| Type | Dissertação |
| Format | application/pdf, application/pdf, application/pdf, application/pdf, application/pdf |
| Rights | openAccess |
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