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Depression as a Risk Factor for the Initial Presentation of Twelve Cardiac, Cerebrovascular, and Peripheral Arterial Diseases: Data Linkage Study of 1.9 Million Women and Men
Department of Infection & Population Health, University College London, London, United Kingdom.
Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
Department of Primary Care & Population Health, University College London, London, United Kingdom.
Division of Psychiatry, University College London, London, United Kingdom.
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 4, e0153838Article in journal (Refereed) Published
Abstract [en]

Background: Depression is associated with coronary heart disease and stroke, but associations with a range of pathologically diverse cardiovascular diseases are not well understood. We examine the risk of 12 cardiovascular diseases according to depression status (history or new onset).

Methods: Cohort study of 1,937,360 adult men and women, free from cardiovascular disease at baseline, using linked UK electronic health records between 1997 and 2010. The exposures were new-onset depression (a new GP diagnosis of depression and/or prescription for antidepressants during a one-year baseline), and history of GP-diagnosed depression before baseline. The primary endpoint was initial presentation of 12 cardiovascular diseases after baseline. We used disease-specific Cox proportional hazards models with multiple imputation adjusting for cardiovascular risk factors (age, sex, socioeconomic status, smoking, blood pressure, diabetes, cholesterol).

Results: Over a median [IQR] 6.9 [2.1-10.5] years of follow-up, 18.9% had a history of depression and 94,432 incident cardiovascular events occurred. After adjustment for cardiovascular risk factors, history of depression was associated with: stable angina (Hazard Ratio = 1.38, 95%CI 1.32-1.45), unstable angina (1.70, 1.60-1.82), myocardial infarction (1.21, 1.16-1.27), unheralded coronary death (1.23, 1.14-1.32), heart failure (1.18, 1.13-1.24), cardiac arrest (1.14, 1.03-1.26), transient ischemic attack (1.31, 1.25-1.38), ischemic stroke (1.26, 1.18-1.34), subarachnoid haemorrhage (1.17, 1.01-1.35), intracerebral haemorrhage (1.30, 1.17-1.45), peripheral arterial disease (1.24, 1.18-1.30), and abdominal aortic aneurysm (1.12,1.01-1.24). New onset depression developed in 2.9% of people, among whom 63,761 cardiovascular events occurred. New onset depression was similarly associated with each of the 12 diseases, with no evidence of stronger associations compared to history of depression. The strength of association between depression and these cardiovascular diseases did not differ between women and men.

Conclusions: Depression was prospectively associated with cardiac, cerebrovascular, and peripheral diseases, with no evidence of disease specificity. Further research is needed in understanding the specific pathophysiology of heart and vascular disease triggered by depression in healthy populations.

Place, publisher, year, edition, pages
San Francisco, USA: Public Library of Science , 2016. Vol. 11, no 4, e0153838
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-49949DOI: 10.1371/journal.pone.0153838ISI: 000374565100025PubMedID: 27105076OAI: oai:DiVA.org:oru-49949DiVA: diva2:923368
Note

Funding Agencies:

National Institute for Health Research RP-PG-0407-10314

Wellcome Trust 086091/Z/08/Z  MR/K006584/1

Medical Research Council Prognosis Research Strategy (PROGRESS) Partnership G0902393/99558

Medical Research Council

Arthritis Research UK

British Heart Foundation

Cancer Research UK

Chief Scientist Office

Economic and Social Research Council

Engineering and Physical Sciences Research Council

National Institute for Health Research

National Institute for Social Care and Health Research

Alzheimer Scotland

University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative G0700704/ 84698

BBSRC

EPSRC

ESRC

MRC

UCL Provost's Strategic Development Fund Fellowship

NIHR Doctoral Fellowship DRF-2009-02-50

Medical Research Council K013351

National Heart, Lung and Blood Institute HL36310

National Institute of Aging AG034454

NIHR

Available from: 2016-04-26 Created: 2016-04-26 Last updated: 2016-06-07Bibliographically approved

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