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Observational Study
. 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

Roxanne Pelletier  1 , Simon L Bacon  2 , André Arsenault  3 , Jocelyn Dupuis  4 , Catherine Laurin  5 , Lucie Blais  6 , Kim L Lavoie  7
Affiliations
Observational Study

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

Roxanne Pelletier et al. BMJ Open. .

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.

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Figures

Figure 1
Figure 1
Raw proportions of all-cause mortality and major adverse cardiovascular events (MACE), according to depressive disorders, anxiety disorders and cardiovascular event (CAD) status.
Figure 2
Figure 2
Survival curves in depressed and non-depressed patients with and without cardiovascular event (CAD).
See this image and copyright information in PMC

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