Researchers at the Uniformed Services University of the Health Sciences (USU) used data garnered from an ongoing study at multiple sites around the U.S. The epidemiological study, the Women’s Ischemia Syndrome Evaluation (WISE), was designed to develop methods for improved assessment and understanding of coronary artery disease in women.
In a paper, “Psychotropic medication use and risk of adverse cardiovascular events in women with suspected coronary artery disease,” lead author David S. Krantz, Ph.D., says there are several important implications of this research for women with suspected CAD.
However, he also emphasizes that the study’s results are not definitive because the study was observation, rather than a clinical trial. An observational study measures associations or relationships (correlations) but cannot state a definitive cause and effect.
“Since depression is an important risk factor for CAD morbidity and mortality, women with suspected CAD may be inadequately treated for depression,” said Dr. Krantz.
“Taking these medications may be a marker of residual depression and residual depression in these women may account for increased CAD events. However, it needs to be considered that taking antidepressant and anti-anxiety medications may not be beneficial, and may in fact be harmful for some women.”
Dr. Krantz also said women with suspected CAD often have unexplained chest pain, since traditional diagnostic methods for CAD — for example, coronary angiography — may not reveal the presence of disease.
“Many women become distressed by the undiagnosed chest pain and are prescribed these medications for this distress,” said Dr. Krantz. Prior findings from the WISE study indicate women with persistent unexplained chest pain have diminished quality of life.
Because the WISE study is not a clinical trial, researchers need to be very cautious about concluding that antidepressant and anti-anxiety medications themselves are responsible for the results of the WISE study, since many factors could be associated with patients using these medications.
For this reason, Krantz said, further research needs to examine whether factors such as underlying depression and anxiety, and not medications per se, may be responsible for these results. These findings also emphasize the importance of emotional and psychosocial factors in women with suspected coronary artery disease.