Antidepressants, autonomic function and mortality in patients with coronary heart disease: data from the Heart and Soul Study

2014 ◽  
Vol 44 (14) ◽  
pp. 2975-2984 ◽  
Author(s):  
F. Zimmermann-Viehoff ◽  
L. K. Kuehl ◽  
H. Danker-Hopfe ◽  
M. A. Whooley ◽  
C. Otte
Keyword(s):  
Heart Rate ◽  
Coronary Heart Disease ◽  
Heart Rate Variability ◽  
Heart Disease ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Autonomic Function ◽  
Control Group ◽  
Observational Period ◽  
Lower Heart Rate

BackgroundAntidepressants reduce depressive symptoms in patients with coronary heart disease, but they may be associated with increased mortality. This study aimed to examine whether the use of tricyclic antidepressants (TCA) or selective serotonin reuptake inhibitors (SSRI) is associated with mortality in patients with coronary heart disease, and to determine whether this association is mediated by autonomic function.MethodA total of 956 patients with coronary heart disease were followed for a mean duration of 7.2 years. Autonomic function was assessed as heart rate variability, and plasma and 24-h urinary norepinephrine.ResultsOf 956 patients, 44 (4.6%) used TCA, 89 (9.3%) used SSRI, and 823 (86.1%) did not use antidepressants. At baseline, TCA users exhibited lower heart rate variability and higher norepinephrine levels compared with SSRI users and antidepressant non-users. At the end of the observational period, 52.3% of the TCA users had died compared with 38.2% in the SSRI group and 37.3% in the control group. The adjusted hazard ratio (HR) for TCA use compared with non-use was 1.74 [95% confidence interval (CI) 1.12–2.69, p = 0.01]. Further adjustment for measures of autonomic function reduced the association between TCA use and mortality (HR = 1.27, 95% CI 0.67–2.43, p = 0.47). SSRI use was not associated with mortality (HR = 1.15, 95% CI 0.81–1.64, p = 0.44).ConclusionsThe use of TCA was associated with increased mortality. This association was at least partially mediated by differences in autonomic function. Our findings suggest that TCA should be avoided in patients with coronary heart disease.

Antidepressants and heart-rate variability in older adults: a population-based study

2015 ◽  
Vol 46 (6) ◽  
pp. 1239-1247 ◽  
Author(s):  
R. Noordam ◽  
M. E. van den Berg ◽  
M. N. Niemeijer ◽  
N. Aarts ◽  
A. Hofman ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Drug Effect ◽  
Population Based ◽  
Study Cohort ◽  
Rotterdam Study ◽  
Lower Heart Rate ◽  
Population Based Study

BackgroundTricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) may be associated with lower heart rate variability (HRV), a condition associated with increased mortality risk. We aimed to investigate the association between TCAs, SSRIs and HRV in a population-based study.MethodIn the prospective Rotterdam Study cohort, up to five electrocardiograms (ECGs) per participant were recorded (1991–2012). Two HRV variables were studied based on 10-s ECG recordings: standard deviation of normal-to-normal RR intervals (SDNN) and root mean square of successive RR interval differences (RMSSD). We compared the HRV on ECGs recorded during use of antidepressants with the HRV on ECGs recorded during non-use of any antidepressant. Additionally, we analysed the change in HRV on consecutive ECGs. Those who started or stopped using antidepressants before the second ECG were compared with non-users on two ECGs.ResultsWe included 23 647 ECGs from 11 729 participants (59% women, mean age 64.6 years at baseline). Compared to ECGs recorded during non-use of antidepressants (n = 22 971), SDNN and RMSSD were lower in ECGs recorded during use of TCAs (n = 296) and SSRIs (n = 380). Participants who started using TCAs before the second ECG had a decrease in HRV and those who stopped had an increase in HRV compared to consistent non-users (p < 0.001). Starting or stopping SSRIs was not associated with HRV changes.ConclusionTCAs were associated with a lower HRV in all analyses, indicating a real drug effect. For SSRIs the results are mixed, indicating a weaker association, possibly due to other factors.

The use of heart rate turbulence and heart rate variability in the assessment of autonomic regulation and circadian rhythm in patients with systemic lupus erythematosus without apparent heart disease

Lupus ◽  
2017 ◽  
Vol 27 (3) ◽  
pp. 436-444 ◽  
Author(s):  
A R Poliwczak ◽  
E Waszczykowska ◽  
B Dziankowska-Bartkowiak ◽  
M Koziróg ◽  
K Dworniak
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Lupus Erythematosus ◽  
High Frequency ◽  
Autonomic Function ◽  
Disease Duration ◽  
Control Group ◽  
Systemic Lupus ◽  
Heart Rate Turbulence

Background Systemic lupus erythematosus is a progressive autoimmune disease. There are reports suggesting that patients even without overt signs of cardiovascular complications have impaired autonomic function. The aim of this study was to assess autonomic function using heart rate turbulence and heart rate variability parameters indicated in 24-hour ECG Holter monitoring. Methods Twenty-six women with systemic lupus erythematosus and 30 healthy women were included. Twenty-four hour ambulatory ECG-Holter was performed in home conditions. The basic parameters of heart rate turbulence and heart rate variability were calculated. The analyses were performed for the entire day and separately for daytime activity and night time rest. Results There were no statistically significant differences in the basic anthropometric parameters. The mean duration of disease was 11.52 ± 7.42. There was a statistically significant higher turbulence onset (To) value in patients with systemic lupus erythematosus, median To = –0.17% (minimum –1.47, maximum 3.0) versus To = –1.36% (minimum –4.53, maximum –0.41), P < 0.001. There were no such differences for turbulence slope (Ts). In the 24-hour analysis almost all heart rate variability parameters were significantly lower in the systemic lupus erythematosus group than in the healthy controls, including SDANN and r-MSSD and p50NN. Concerning the morning activity and night resting periods, the results were similar as for the whole day. In the control group, higher values in morning activity were noted for parameters that characterise sympathetic activity, especially SDANN, and were significantly lower for parasympathetic parameters, including r-MSSD and p50NN, which prevailed at night. There were no statistically significant changes for systemic lupus erythematosus patients for p50NN and low and very low frequency. There was a positive correlation between disease duration and SDNN, R = 0.417; P < 0.05 and SDANN, R = 0.464; P < 0.05, a negative correlation between low/high frequency ratio and r-MSSD, R = –0.454; P < 0.05; p50NN, R = –0.435; P < 0.05 and high frequency, R = –0.478; P < 0.05. In contrast, there was no statistically significant correlation between heart rate turbulence and other variables evaluated, including disease duration and the type of autoantibodies. Conclusion: Our study confirms the presence of autonomic disorders with respect to both heart rate variability and heart rate turbulence parameters and the presence of diurnal disturbances of sympathetic–parasympathetic balance. Further studies are required.

Non-linear analysis of heart rate variability in patients with coronary heart disease

2003 ◽  
Author(s):  
G. Krstacic ◽  
A. Krstacic ◽  
M. Martinis ◽  
E. Vargovic ◽  
A. Knezevic ◽  
...  
Keyword(s):  
Heart Rate ◽  
Coronary Heart Disease ◽  
Heart Rate Variability ◽  
Heart Disease ◽  
Linear Analysis ◽  
Non Linear
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