BACKGROUND Mental disorders have a high comorbidity with cardiovascular disease (CVD), but the causality between them has not been fully appreciated. OBJECTIVE This study aimed to systematically explore the bidirectional causality between the two broad categories of diseases. METHODS We conducted Mendelian randomisation (MR) and multivariable MR (MVMR) analyses to evaluate potential causal links between 10 mental disorders, the use of antidepressants and 7 CVDs. FINDINGS We discovered that major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD) and insomnia exhibit connections with elevated risks of two or more CVDs. Moreover, the use of antidepressants is linked to heightened risks of each CVD. Each distinct CVD is correlated with a greater probability of taking antidepressants. Our MVMR analysis demonstrated that the use of antidepressants is correlated with the elevation of respective risks across all cardiovascular conditions. This includes arrhythmias (OR: 1.28), atrial fibrillation (OR: 1.44), coronary artery disease (OR: 1.16), hypertension (OR: 1.16), heart failure (OR: 1.16), stroke (OR: 1.44) and entire CVD group (OR: 1.35). However, MDD itself was not linked to a heightened risk of any CVD. CONCLUSIONS The findings of our study indicate that MDD, insomnia and ADHD may increase the risk of CVD. Our findings highlight the utilisation of antidepressants as an independent risk factor for CVD, thus explaining the influence of MDD on CVD through the mediating effects of antidepressants. CLINICAL IMPLICATIONS When treating patients with antidepressants, it is necessary to take into consideration the potential beneficial and detrimental effects of antidepressants.

中文翻译：

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精神障碍、抗抑郁药和心血管疾病之间的双向关联。


背景精神障碍与心血管疾病（CVD）有很高的合并症，但它们之间的因果关系尚未得到充分认识。目的本研究旨在系统地探讨两大类疾病之间的双向因果关系。方法 我们进行了孟德尔随机化 (MR) 和多变量 MR (MVMR) 分析，以评估 10 种精神障碍、抗抑郁药的使用和 7 种心血管疾病之间的潜在因果关系。研究结果 我们发现，重度抑郁症 (MDD)、注意力缺陷/多动障碍 (ADHD) 和失眠与两种或多种心血管疾病的风险升高有关。此外，抗抑郁药的使用与各种心血管疾病的风险增加有关。每种不同的心血管疾病都与服用抗抑郁药物的更大可能性相关。我们的 MVMR 分析表明，抗抑郁药的使用与所有心血管疾病各自风险的升高相关。这包括心律失常（OR：1.28）、心房颤动（OR：1.44）、冠状动脉疾病（OR：1.16）、高血压（OR：1.16）、心力衰竭（OR：1.16）、中风（OR：1.44）和整个CVD组（OR：1.35）。然而，MDD 本身与任何 CVD 风险增加无关。结论 我们的研究结果表明，MDD、失眠和 ADHD 可能会增加 CVD 的风险。我们的研究结果强调了抗抑郁药的使用作为 CVD 的独立危险因素，从而解释了 MDD 通过抗抑郁药的中介作用对 CVD 的影响。临床意义 当用抗抑郁药治疗患者时，有必要考虑抗抑郁药的潜在有益和有害作用。