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ORIGINAL RESEARCH article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1509941
This article is part of the Research Topic Cardiovascular Comorbidities in Inflammatory Rheumatic Diseases View all 7 articles
Association of SSRI and SNRI Use with Incidence of Cardiovascular Events in Veterans with Giant Cell Arteritis and Polymyalgia Rheumatica
Provisionally accepted
Tianyu Zhang 1 Chris A Gentry 2 Nicole M Kuderer 3
Gary H Lyman 4,5 Bernard Ng 6
Despina Michailidou 2,7*- 1 Department of Statistics and Data Science, Dietrich College of Humanities and Social Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- 2 Oklahoma City VA Health Care System, North Florida/South Georgia Veterans Health System, Veterans Health Administration, United States Department of Veterans Affairs, Oklahoma City, Oklahoma, United States
- 3 Advanced Cancer Research Group, Kirkland, Washington, United States
- 4 Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, United States
- 5 Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA; Schools of Medicine, Public Health and Pharmacy, University of Washington, Seattle, California, United States
- 6 VA National Rheumatology Program, Seattle, California, United States
- 7 University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
The leading cause of death in patients with giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) is cardiovascular disease. The objective of this study was to determine whether the use of SSRI and SNRI in veterans with GCA and PMR could have a cardio-modulatory effect as compared to nonuse.Patients with GCA and PMR were identified through the Veterans Affairs Informatics and Computing Infrastructure. After a 2:1 propensity score matching for SSRI or SNRI users, we identified nonusers with similar covariates. We then applied a multivariate logistic regression (MLR), to calculate the odds ratio (OR) for cardiovascular event (CVE) outcomes within 5 years after the index date. Related hazard ratios (HR) were also calculated to validate the discovery of our findings.We identified 2249 patients with GCA and 3906 patients with PMR. Among patients with GCA, 174 (27%) SSRI users had incident cardiovascular disease as compared to 47 (28%) SNRI users and 277 (19%) nonusers; in the PMR cohort, 108 (13%) were SSRI users compared to 71 (15%) SNRI users and 255 (11%) nonusers. The adjusted ORs of the CVE outcome associated with venlafaxine (2.44, p=0.01) and sertraline (1.45, p=0.04) were significantly greater than 1 in GCA, with similar results observed in the PMR cohort (2.01, p=0.02, and 1.45, p=0.04, respectively).Cox-regression analysis was also conducted, and the hazard ratios were qualitatively consistent with the MLR analysis. In conclusion, the adjusted risk of CVE in patients with GCA or PMR using either venlafaxine or sertraline was higher than that in the non-exposed groups.
Keywords: giant cell arteritis, polymyalgia rheumatica, SSRI, SNRI, ischemic stroke, TIA, myocardial infarction, angina Abbreviations: GCA, giant cell arteritis, PMR, polymyalgia rheumatica, SSRI, selective serotonin reuptake inhibitors, SNRI, serotonin norepinephrine reuptake inhibitors, MLR, multivariate logistic regression, CVE, cardiovascular event, TIA, transient ischemic attack, MI, myocardial infarct
Received: 11 Oct 2024; Accepted: 31 Mar 2025.
Copyright: © 2025 Zhang, Gentry, Kuderer, Lyman, Ng and Michailidou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Despina Michailidou, University of Oklahoma Health Sciences Center, Oklahoma City, 73104, Oklahoma, United States
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