Depression, anxiety should be considered in determining patients' CHD risk

25 June 2008

MedWire News: Depression and anxiety should be considered risk factors for coronary artery disease, say scientists after finding both conditions are associated with the incidence of acute myocardial infarction (AMI).

Although there is increasing evidence that depression increases the risk for acute coronary syndromes, depressive disease is not included in the list of important and independent risk factors for cardiovascular disease, and it is still not common practice for clinicians to screen for depression, explain the researchers.

To quantify the association between depression and AMI, Anne Jakobsen, from Aarhus University Hospital in Denmark, and colleagues studied all patients aged over 15 years from the Danish Psychiatric Central Research Register diagnosed with an affective disorder of a depressive type between 1977 and 2000.

These patients were compared with age- and gender-matched controls for episodes of AMI during a follow-up period of 24 years.

In all, 59,049 depressed patients were compared with 269,300 controls. The team also studied 13,970 anxiety patients, matched with 61,891 controls, and 15,710 schizophrenia patients, matched with 69,447 controls, in order to provide comparator diagnostic groups.

The incidence of AMI during follow-up was 3.21% for depressed patients, compared with 3.18% among controls. For anxiety patients and their controls, and schizophrenia patients and their controls, the respective incidence of AMI was 1.90% versus 1.27% and 1.10% versus 1.19%.

Taking into account age and gender and using the Maental-Haenszel method, the researchers found that the incidence rate ratio for AMI was significantly increased among depressed patients compared with controls, at 1.16.

For patients with anxiety, the incidence rate ratio of AMI was even higher versus controls, at 1.56, while that for schizophrenia was significantly lower compared with controls, at 0.77.

The team concludes: "This study quantifies associations linking both depression and anxiety with an increased risk of AMI. As the association was not demonstrated for those with schizophrenia, our findings argue for some diagnostic specificity.

"Consequently, both depression and anxiety should be included along with other traditional cardiovascular risk factors in identifying those at risk of coronary heart disease morbidity," the team writes in the Journal of Affective Disorders.

J Affect Disord 2008; 109: 177-181