Copyright © 2003 by the European Society of Cardiology.
Clinical research
Depression and cardiovascular morbidity and mortality: cause or consequence?
a Green Lane Hospital, Auckland, New Zealand
b Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
c National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
d Wesley Medical Centre, Brisbane, Australia
e Department of Medicine, University of Queensland, Brisbane, Australia
f Department of Medicine, University of Auckland, Auckland, New Zealand
g Austin and Repatriation Medical Centre, Melbourne, Australia
h Monash University, Melbourne, Australia
i The National Heart Foundation of Australia, Melbourne, Australia
* Correspondence to: Dr Ralph Stewart, Cardiology Department, Green Lane Hospital, Private Bag 92-189, Auckland 1030, New Zealand. Tel: +64-9-630 9903; Fax: +64-9-630 9978
E-mail address: rstewart{at}adhb.govt.nz
Received 19 January 2003; revised 14 July 2003; accepted 21 August 2003
Abstract
Background Depression after myocardial infarction has been associated with increased cardiovascular mortality. This study assessed whether depressive symptoms were associated with adverse outcomes in people with a history of an acute coronary syndrome, and evaluated possible explanations for such an association.
Methods and results Depressive symptoms were assessed using the General Health Questionnaire at least 5 months after hospital admission for acute myocardial infarction or unstable angina in 1130 participants of the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study, a multicentre, placebo-controlled, clinical trial of cholesterol-lowering treatment. Cardiovascular symptoms, self-rated general health, cardiovascular risk factors, employment status, social support and life events were also assessed at the baseline visit. Cardiovascular death (n=114), non-fatal myocardial infarction (n=108), non-fatal stroke (n=53) and unstable angina (n=274) were documented during a median follow-up period of 8.1 years. Individuals with depressive symptoms (General Health Questionnaire score 
5; 22% of participants) were more likely to report angina, dyspnoea, claudication, poorer general health, not being in paid employment, few social contacts and/or adverse life events (P<0.05 for all). There was a modest association between depressive symptoms and cardiovascular events (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.13–1.77), but not cardiovascular death (HR 1.12. 95% CI 0.71–1.77). After adjustment for symptoms related to cardiovascular disease, the HR for cardiovascular events was 1.22 (95% CI 0.97–1.53). After further adjustment for employment status, social support and life events, the HR was 1.13 (95% confidence interval 0.87–1.47).
Conclusions There was no significant association between depressive symptoms and fatal or non-fatal cardiovascular events after adjustment for cardiovascular symptoms associated with poorer prognosis. Previously observed associations between depression and cardiovascular mortality may not be causal.
Key Words: Cardiovascular disease • Depression • General HealthQuestionnaire • Mortality • Myocardial infarction
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in EHJ:
- Depression and cardiovascular disease: a complex relationship
- Norman Sharpe
EHJ 2003 24: 1997-1998.[Extract] [FREE Full Text]
This article has been cited by other articles:
|
|
 |
|
  H. Lett, S. Ali, and M. Whooley Depression and Cardiac Function in Patients With Stable Coronary Heart Disease: Findings From the Heart and Soul Study Psychosom Med, May 1, 2008; 70(4): 444 - 449. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-K. Wong, E.W. Tang, P. Herbison, B. Birmingham, L. Barclay, and S.Y.F. Fu Pre-existent depression in the 2 weeks before an acute coronary syndrome can be associated with delayed presentation of the heart attack QJM, February 1, 2008; 101(2): 137 - 144. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. N. Jacka, J. A. Pasco, S. McConnell, L. J. Williams, M. A. Kotowicz, G. C. Nicholson, and M. Berk Self-Reported Depression and Cardiovascular Risk Factors in a Community Sample of Women Psychosomatics, February 1, 2007; 48(1): 54 - 59. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Whooley Depression and cardiovascular disease: healing the broken-hearted. JAMA, June 28, 2006; 295(24): 2874 - 2881. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. E. Egede, P. J. Nietert, and D. Zheng Depression and All-Cause and Coronary Heart Disease Mortality Among Adults With and Without Diabetes Diabetes Care, June 1, 2005; 28(6): 1339 - 1345. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Steptoe and D L Whitehead Depression, stress, and coronary heart disease: the need for more complex models Heart, April 1, 2005; 91(4): 419 - 420. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Barth, M. Schumacher, and C. Herrmann-Lingen Depression as a Risk Factor for Mortality in Patients With Coronary Heart Disease: A Meta-analysis Psychosom Med, November 1, 2004; 66(6): 802 - 813. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Frasure-Smith, F. Lesperance, R. M Carney, and K. E Freedland Probable need for psychiatric treatment is not the same as depression Eur. Heart J., June 1, 2004; 25(11): 994 - 995. [Full Text] [PDF]
|
|
|
|
|
|
R. A.H Stewart, H. D White, F. M North, and K. J Sharples Bias in the evaluation of evidence linking depression to cardiovascular mortality: reply Eur. Heart J., June 1, 2004; 25(11): 995 - 995. [Full Text] [PDF]
|
|
|
|
|
|
N. Sharpe Depression and cardiovascular disease: a complex relationship Eur. Heart J., November 2, 2003; 24(22): 1997 - 1998. [Full Text] [PDF]
|
|