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J Am Heart Assoc. 2019 Nov 5;8(21):e012535. doi: 10.1161/JAHA.119.012535. Epub 2019 Oct 23.

Symptoms of Depression and Risk of Abdominal Aortic Aneurysm: A HUNT Study.

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Department of Vascular Surgery St. Olavs Hospital Trondheim Norway.
Department of Circulation and Medical Imaging NTNU- Norwegian University of Science and Technology Trondheim Norway.
Perioperative Medicine and Intensive Care Function University Hospital Stockholm Sweden.
Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.
Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden.
Department of Public Health and Nursing NTNU- Norwegian University of Science and Technology Trondheim Norway.
Department of Immunology and Transfusion Medicine St. Olavs Hospital Trondheim Norway.
Department of Clinical and Molecular Medicine NTNU- Norwegian University of Science and Technology Trondheim Norway.


Background Depression is associated with cardiovascular diseases, but the evidence is scarce regarding depression and risk of abdominal aortic aneurysms (AAA). The aim was to determine whether individuals with depressive symptoms have increased risk of AAA. Methods and Results This population-based prospective study included 59 136 participants (52.4% women) aged 50 to 106 years from the HUNT (Norwegian Nord-Trøndelag Health Study). Symptoms of depression were assessed using the depression subscale of the Hospital Anxiety and Depression Scale (HADS). During a median follow-up of 13 years, there were 742 incident cases of AAA (201 women). A total of 6401 individuals (12.3%) reported depressive symptoms (defined as HADS depression scale [HADS-D]) ≥8) (52.5% women). The annual incidence rate of AAA was 1.0 per 1000 individuals. At all ages, the estimated proportion of individuals diagnosed with AAA was higher among those with depressive symptoms (log-rank test, P<0.001). People with HADS-D ≥8 were older than those with HADS-D<8 (median 57.8 versus 52.3 years, P<0.001) and a statistically significantly higher proportion of them (P<0.001) were smokers, overweight or obese, and reported a history of coronary heart disease, diabetes mellitus, and hypertension. In a Cox proportional hazard regression model adjusted for these factors, individuals with depressive symptoms had a ≈30% higher risk of AAA than those without (hazard ratio, 1.32, 95% CI 1.08-1.61, P=0.007). Conclusions This study shows that individuals with depressive symptoms have significantly higher risk of incident AAA, after adjustments for established risk factors.


HADS score; HUNT study; abdominal aortic aneurysm; depression; depressive symptoms; risk factors

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