Depression and cardiovascular morbidity and mortality: cause or consequence?

Stewart, RAH, North, FM, West, TM, Sharples, KJ, Simes, RJ, Colquhoun, DM, White, HD, Tonkin, AM and LIPID Study Investigators (2003) Depression and cardiovascular morbidity and mortality: cause or consequence?. European Heart Journal, 24 22: 2027-2037. doi:10.1016/j.ehj.2003.08.017

Author Stewart, RAH
North, FM
West, TM
Sharples, KJ
Simes, RJ
Colquhoun, DM
White, HD
Tonkin, AM
LIPID Study Investigators
Title Depression and cardiovascular morbidity and mortality: cause or consequence?
Journal name European Heart Journal   Check publisher's open access policy
ISSN 0195-668X
Publication date 2003-01-01
Sub-type Article (original research)
DOI 10.1016/j.ehj.2003.08.017
Open Access Status Not Open Access
Volume 24
Issue 22
Start page 2027
End page 2037
Total pages 11
Editor Dr K. M. Fox
Place of publication United Kingdom
Publisher W.B. Saunders Co Ltd
Language eng
Subject C1
321003 Cardiology (incl. Cardiovascular Diseases)
730106 Cardiovascular system and diseases
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 greater than or equal to5; 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. (C) 2003 Published by Elsevier Ltd on behalf of The European Society of Cardiology.
Keyword Cardiac & Cardiovascular Systems
Cardiovascular Disease
General Health
Myocardial Infarction
Acute Myocardial-infarction
Long-term Mortality
Psychosocial Factors
Cardiac Mortality
Unstable Angina
Social Support
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2004 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 60 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 64 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 12:48:53 EST