08 Jun Women On Both Diabetes and Depression Medications Have Increased Risk of Myocardial Infarction
MedicalResearch.com Interview with
Dr. Karin Rådholm MD Ph.D. student
Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University
Department of Local Care West, County Council of Östergötland,
MedicalResearch: What is the background for this study?
Dr. Rådholm: Psychosocial risk factors and depressive disorders often co-occur with general medical comorbidities, such as myocardial infarction. Depression is more common in patients with diabetes than in patients without diabetes. About 10-30% of patients with diabetes have a comorbid depressive disorder, which is double the estimated prevalence of depression in individuals without diabetes. There is an association between comorbid depressive symptoms and diabetes complications. This is believed to be mainly due to poor adherence to treatment recommendations and diabetes self-management activities, but could also possibly be due to biological and behavioural causes that could predispose for both metabolic and affective disorders. The general risk of myocardial infarction is strongly dependent on age and sex, where men have an earlier disease onset compared to women. In the general population women are at much lower risk for ischemic heart disease mortality than men are. However, women with diabetes are at especially high risk for coronary heart disease, relatively more so than men with type 2 diabetes, meaning that the impact of diabetes on the risk of coronary death is significantly greater for women than men. The age- and gender-specific risk for myocardial infarction due to diabetes with coexistent depression has not previously been described. Data on all dispensed drug prescriptions in Sweden are available in the Swedish Prescribed Drug Register and all myocardial infarctions are registered in the Myocardial Infarction Statistics. These registers are population-based and have a total national coverage and high validity, which has been previously shown. Prescribed and dispensed antidiabetics and antidepressants were used as markers of disease.
Our objective was to prospectively explore the gender- and age-specific risk of first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared to participants with no pharmaceutical treatment for diabetes or depression in a nationwide register study.
MedicalResearch: What are the main findings?
Dr. Rådholm: The main findings from this population-based, nation-wide register study of 3 965 839 participants, are that the combination of pharmacologically treated diabetes mellitus and use of antidepressants substantially increased the risk of a first myocardial infarction compared to categories of none or either of the conditions alone.
The hazard ratio for having a first myocardial infarction for women 45-64 years with antidiabetics and antidepressants combined was increased over 7 times vs. women not having either diabetes or depression. The corresponding hazard ratio in men was 3.1.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Rådholm: All patients, especially women with comorbid diabetes and depression should be given careful attention for risk factor control.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Rådholm: Future research should include randomised controlled trials addressing depression treatment and disease mechanisms in diabetes patients.
Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study
Dr. Karin Rådholm MD Ph.D., & Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University (2015). Women On Both Diabetes and Depression Medications Have Increased Risk of Myocardial Infarction MedicalResearch.com
Last Updated on November 4, 2015 by Marie Benz MD FAAD