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BMJ Open. 2015 Dec 15;5(12):e006582. doi: 10.1136/bmjopen-2014-006582.

Relative associations between depression and anxiety on adverse cardiovascular events: does a history of coronary artery disease matter? A prospective observational study.

Author information

1
Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Research Centre, Montreal Heart Institute- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Montréal, Québec, Canada.
2
Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Research Centre, Montreal Heart Institute- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Research Centre, Hôpital du Sacré-Cœur de Montréal- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.
3
Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Research Centre, Montreal Heart Institute- a University of Montreal affiliated Hospital, Montréal, Québec, Canada.
4
Research Centre, Montreal Heart Institute- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Departement of Medicine, Université de Montréal, Montreal, Quebec, Canada.
5
Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Research Centre, Montreal Heart Institute- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Research Centre, Hôpital du Sacré-Cœur de Montréal- a University of Montreal affiliated Hospital, Montréal, Québec, Canada.
6
Research Centre, Hôpital du Sacré-Cœur de Montréal- a University of Montreal affiliated Hospital, Montréal, Québec, Canada.
7
Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Research Centre, Montreal Heart Institute- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Research Centre, Hôpital du Sacré-Cœur de Montréal- a University of Montreal affiliated Hospital, Montréal, Québec, Canada Department of Psychology, University of Québec at Montréal (UQAM), Montréal, Québec, Canada.

Abstract

OBJECTIVES:

To assess whether depression and anxiety increase the risk of mortality and major adverse cardiovascular events (MACE), among patients with and without coronary artery disease (CAD).

DESIGN AND SETTING, AND PATIENTS:

DECADE (Depression Effects on Coronary Artery Disease Events) is a prospective observational study of 2390 patients referred at the Montreal Heart Institute. Patients were followed for 8.8 years, between 1998 and 2009. Depression and anxiety were assessed using a psychiatric interview (Primary Care Evaluation of Mental Disorders, PRIME-MD). Outcomes data were obtained from Quebec provincial databases.

MAIN OUTCOME MEASURES:

All-cause mortality and MACE.

RESULTS:

After adjustment for covariates, patients with depression were at increased risks of all-cause mortality (relative risk (RR)=2.84; 95% CI 1.25 to 6.49) compared with patients without depression. Anxiety was not associated with increased mortality risks (RR=0.86; 95% CI 0.31 to 2.36). When patients were stratified according to CAD status, depression increased the risk of mortality among patients with no CAD (RR=4.39; 95% CI 1.12 to 17.21), but not among patients with CAD (RR=2.32; 95% CI 0.78 to 6.88). Neither depression nor anxiety was associated with MACE among patients with or without CAD.

CONCLUSIONS AND RELEVANCE:

Depression, but not anxiety, was an independent risk factor for all-cause mortality in patients without CAD. The present study contributes to a better understanding of the relative and unique role of depression versus anxiety among patients with versus without CAD.

KEYWORDS:

EPIDEMIOLOGY; MENTAL HEALTH

PMID:
26671946
PMCID:
PMC4679922
DOI:
10.1136/bmjopen-2014-006582
[Indexed for MEDLINE]
Free PMC Article

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