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J Am Heart Assoc. 2019 Jan 8;8(1):e010603. doi: 10.1161/JAHA.118.010603.

Negative Affect and Risk of Atrial Fibrillation: MESA.

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1 Division of Cardiology University of Southern California Keck School of Medicine Los Angeles CA.
2 Division of Cardiology Emory University School of Medicine Atlanta GA.
3 Urban Health Collaborative, and Office of Dean Dornsife School of Public Health Drexel University Philadelphia PA.
4 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.
5 Department of Epidemiology and Prevention Epidemiological Cardiology Research Center (EPICARE) Wake Forest School of Medicine Winston-Salem NC.
6 Section on Cardiology Department of Medicine Wake Forest School of Medicine Winston-Salem NC.
7 Department of Epidemiology University of Washington Seattle WA.


Background Current literature examining the prospective relationship between depression and other measures of negative affect with atrial fibrillation (AF) are limited. We determined the relationships of depression, anger, anxiety, and chronic stress with incident AF in a multiethnic cohort of middle- and older-aged adults. Methods and Results This analysis included 6644 MESA (Multi-Ethnic Study of Atherosclerosis) study participants who were free of AF at baseline. Depressive symptoms were assessed at baseline and defined as either a 20-item Center for Epidemiologic Studies Depression Scale score ≥16 or use of antidepressant medications. The Spielberger Trait Anger Scale, Spielberger Trait Anxiety Scale, and Chronic Burden Scale were also administered at baseline to assess anger, anxiety, and chronic stress, respectively. The primary outcome was incident AF , identified by follow-up study visit ECGs, hospital discharge diagnoses, or Medicare claims data. A total of 875 (13%) incident AF cases were detected over a median follow-up of nearly 13 years. A Center for Epidemiologic Studies Depression Scale score ≥16 (referent, Center for Epidemiologic Studies Depression Scale score <2) and antidepressant use were associated with a 34% and 36% higher risk of AF , respectively, in separate adjusted Cox proportional hazards analyses (hazard ratio, 1.34; 95% CI 1.04-1.74 for Center for Epidemiologic Studies Depression Scale ≥16; hazard ratio, 1.36; 95% CI , 1.04-1.77 for antidepressant use). No significant associations were observed for anger, anxiety, or chronic stress with development of AF . Conclusions Depressive symptoms are associated with an increased risk of incident AF . Further study into whether improving depressive symptoms reduces AF incidence is important.


arrhythmia; atrial fibrillation; depression

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