Arq Bras CardiolabcArquivos Brasileiros de CardiologiaArq. Bras. Cardiol.0066-782X1678-4170Sociedade Brasileira de Cardiologia - SBCvq4sHqb5RtzpLGWmgMLvBZyS0066-782X201600420028510.5935/abc.20160136Letter to the EditorHeart Rate Recovery and Selective Serotonin Reuptake InhibitorsCeritLeventNear East UniversityNicosiaCyprusNear East University, Nicosia - CyprusMailing Address: Levent Cerit, Near East University. Postal Code 07100, Nicosia - Cyprus. E-mail: drcerit@hotmail.com, drcerit@yahoo.com0920161073285286060620162707201628072016This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.KeywordsHeart RateTobacco UseAntidepressive Agents
To the Editor,
I have read, with great interest, the article entitled "Influence of Smoking Consumption and Nicotine Dependence Degree in Cardiac Autonomic Modulation" by Santos et al.,1 recently published in Arquivos Brasileiros de Cardiologia 2016; 106: 510-8. The reseearchers reported that only the intensity of smoking consumption had influences over cardiac autonomic modulation of the evaluated smokers. Smokers with severe smoking consumption intensity presented worse autonomic modulation than moderate ones.1
Antidepressant medications are a first-line treatment option for moderate to severe mood and anxiety disorders; however, some studies suggest that long-term use may be associated with an increased risk for cardiovascular disease.2-4
Kemp et al.5 reported that all users of selective serotonin reuptake inhibitor - except fluoxetine - display alterations in heart rate or heart rate variability (HRV) in comparison to non users. Similarly, users of paroxetine also display small to moderate reductions in HRV relative to users of citalopram, fluoxetine, and sertraline, but not escitalopram.
In this context, it might be beneficial to give more details about medications due to their effect on cardiac autonomic activity.
References1 Santos AP, Ramos D, Oliveira GM, Santos AA, Freire AP, Ito JT, et al. Influence of smoking consumption and nicotine dependence degree in cardiac autonomic modulation. Arq Bras Cardiol. 2016;106(6):510-8.SantosAPRamosDOliveiraGMSantosAAFreireAPItoJTInfluence of smoking consumption and nicotine dependence degree in cardiac autonomic modulationArq Bras Cardiol201610665105182 Hamer M, Batty GD, Seldenrijk A, Kivimaki M. Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey. Eur Heart J. 2011;32(4):437-42.HamerMBattyGDSeldenrijkAKivimakiMAntidepressant medication use and future risk of cardiovascular disease: the Scottish Health SurveyEur Heart J20113244374423 Smoller JW, Allison M, Cochrane BB, Curb JD, Perlis RH, Robinson JG, et al. Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the women's health initiative study. Arch Intern Med 2009;169(22):2128-39.SmollerJWAllisonMCochraneBBCurbJDPerlisRHRobinsonJGAntidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the women's health initiative studyArch Intern Med200916922212821394 Whang W, Kubzansky LD, Kawachi I, Rexrode KM, Kroenke CH, Glynn RJ, et al Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses' Health Study. J Am Coll Cardiol. 2009;53(11):950-8.WhangWKubzanskyLDKawachiIRexrodeKMKroenkeCHGlynnRJDepression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses' Health StudyJ Am Coll Cardiol200953119509585 Kemp AH, Fráguas R, Brunoni AR, Bittencourt MS, Nunes MA, Dantas EM, et al. Differential associations of specific selective serotonin reuptake inhibitors with resting-state heart rate and heart rate variability: implications for health and well-being. Psychosom Med. 2016 May 23. [Epub ahead of print]KempAHFráguasRBrunoniARBittencourtMSNunesMADantasEMDifferential associations of specific selective serotonin reuptake inhibitors with resting-state heart rate and heart rate variability: implications for health and well-beingPsychosom Med23052016Epub ahead of printReplyReplySantosAna Paula Soares dos
Firstly, I would like to thank you for your interest in our manuscript entitled "Influence of Smoking Consumption and Nicotine Dependence Degree in Cardiac Autonomic Modulation" by Santos APS et al., recently published in this magazine.
As described in the Methods section of the study, individuals on medications that influence cardiac autonomic modulation were not included. Antidepressants, which are among said medications, are commonly used by smokers, sometimes as a part of a drug therapy to aid in the cessation of the smoking habit.
Even though participants of the study were part of an Antismoking Awareness and Orientation Program, which consists of the association of cognitive behavioral and drug therapy, they had not yet started the offered treatment, and the cardiac autonomic modulation evaluation was done with smokers who were not abstinent or on specific cessation medication.
Given the above, we can state that, in our study, there was no influence of medications that could alter cardiac autonomic modulation.
Ana Paula Soares dos SantosCarta ao EditorRecuperação da Frequência Cardíaca e Inibidores Seletivos da Recaptação de SerotoninaCeritLeventNear East University, Nicosia – CyprusCorrespondência: Levent Cerit, Near East University. Postal Code 07100, Nicosia - Chipre. E-mail: drcerit@hotmail.com, drcerit@yahoo.comPalavras-chaveFrequência cardíacaUso de TabacoAntidepressivos
Ao Editor,
Foi com grande interesse que li o artigo intitulado "Influência do Consumo Tabagístico e Grau de Dependência Nicotínica na Modulação Autonômica Cardíaca" de Santos et al.,1 recentemente publicado nos Arquivos Brasileiros de Cardiologia 2016; 106: 510-8. Os pesquisadores relataram que apenas a intensidade do consumo tabagístico exerceu influência sobre a modulação autonômica cardíaca dos fumantes avaliados. Fumantes com grave intensidade de consumo apresentaram modulação autonômica pior do que aqueles com intensidade moderada.1
Medicamentos antidepressivos são uma opção de tratamento de primeira linha para transtornos de ansiedade moderados a graves; porém, alguns estudos sugerem que seu uso a longo-prazo pode estar associado ao aumento do risco de doenças cardiovasculares.2-4
Kemp et al.5 relataram que todos os usuários de inibidores seletivos da recaptação de serotonina - exceto fluoxetina - apresentam alterações na frequência cardíaca ou na variabilidade da frequência cardíaca (VFC) em comparação a não-usuários. Da mesma forma, usuários de paroxetina também demonstram redução leve a moderada na VFC em relação a usuários de citalopram, fluoxetina e sertralina, porém não em comparação a escitalopram.
Neste contexto, pode ser benéfico termos mais detalhes sobre medicamentos, devido a seu efeito na atividade autonômica cardíaca.
Referências1 Santos AP, Ramos D, Oliveira GM, Santos AA, Freire AP, Ito JT, et al. Influence of smoking consumption and nicotine dependence degree in cardiac autonomic modulation. Arq Bras Cardiol. 2016;106(6):510-8.SantosAPRamosDOliveiraGMSantosAAFreireAPItoJTInfluence of smoking consumption and nicotine dependence degree in cardiac autonomic modulationArq Bras Cardiol201610665105182 Hamer M, Batty GD, Seldenrijk A, Kivimaki M. Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey. Eur Heart J. 2011;32(4):437-42.HamerMBattyGDSeldenrijkAKivimakiMAntidepressant medication use and future risk of cardiovascular disease: the Scottish Health SurveyEur Heart J20113244374423 Smoller JW, Allison M, Cochrane BB, Curb JD, Perlis RH, Robinson JG, et al. Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the women's health initiative study. Arch Intern Med 2009;169(22):2128-39.SmollerJWAllisonMCochraneBBCurbJDPerlisRHRobinsonJGAntidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the women's health initiative studyArch Intern Med200916922212821394 Whang W, Kubzansky LD, Kawachi I, Rexrode KM, Kroenke CH, Glynn RJ, et al Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses' Health Study. J Am Coll Cardiol. 2009;53(11):950-8.WhangWKubzanskyLDKawachiIRexrodeKMKroenkeCHGlynnRJDepression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses' Health StudyJ Am Coll Cardiol200953119509585 Kemp AH, Fráguas R, Brunoni AR, Bittencourt MS, Nunes MA, Dantas EM, et al. Differential associations of specific selective serotonin reuptake inhibitors with resting-state heart rate and heart rate variability: implications for health and well-being. Psychosom Med. 2016 May 23. [Epub ahead of print]KempAHFráguasRBrunoniARBittencourtMSNunesMADantasEMDifferential associations of specific selective serotonin reuptake inhibitors with resting-state heart rate and heart rate variability: implications for health and well-beingPsychosom Med23052016Epub ahead of printCarta-respostaCarta-respostaSantosAna Paula Soares dos
Primeiramente, gostaríamos de agradecer o interesse em nosso manuscrito intitulado "Influência do consumo tabagístico e grau de dependência nicotínica na modulação autonômica cardíaca" de Santos APS et al., publicado recentemente nesta revista.
Assim como descrito na seção Métodos do estudo, nesse, não foram incluídos indivíduos que utilizassem medicamentos que influenciassem a modulação autonômica cardíaca, entre eles antidepressivos - comumente utilizados por tabagistas -, até mesmo como terapia medicamentosa para auxiliar na cessação do hábito tabagístico.
Apesar de os participantes do estudo fazerem parte de um Programa de Orientação e Conscientização Antitabagismo, que consiste na associação da terapia cognitivo-comportamental com a medicamentosa, tais participantes ainda não haviam iniciado o tratamento oferecido, e a avaliação da modulação autonômica cardíaca foi realizada com os tabagistas ainda não abstinentes ou em uso de medicações específicas para a cessação. Diante do exposto, podemos afirmar que não houve, em nosso estudo, influência de medicamentos que pudessem alterar a modulação autonômica cardíaca.