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Depression and risk of acute MI – the HUNT 2 study

Self-reported symptoms of depression and anxiety, especially if recurrent, are moderately associated with the risk of incident acute myocardial infarction (AMI), which may reflect reverse causation or confounding from common chronic diseases, according to a study published recently in the European Heart Journal.1

Researchers aimed to study the prospective association of single and recurrent self-reported symptoms of anxiety and depression with a risk of AMI in a large Norwegian population based cohort.

In the second wave of the Nord-Trøndelag Health Study (HUNT2, 1995–97) baseline data on anxiety and depression symptoms, sociodemographic variables, health status including cardiovascular risk factors and common chronic disorders were registered for 57,953 adult men and women free of cardiovascular disease. The cohort was followed up during a mean (SD) 11.4 (2.9) years for a first AMI from baseline through 2008. A total of 2,111 incident AMIs occurred, either identified at hospitals or by the National Cause of Death Registry.

The multi-adjusted hazard ratios were 1.31 (95% CI 1.03–1.66) for symptoms of depression and 1.25 (CI 0.99–1.57) for anxiety. Two episodes of mixed symptoms of anxiety and depression (MSAD), reported 10 years apart, increased the risk for AMI by 52% (11–108%). After exclusion of the first 5 years of follow-up, the association of depression symptoms with AMI risk was attenuated. Relative risk for AMI with anxiety symptoms and MSAD weakened when participants with chronic disorders were excluded.

Ms Lise Tuset Gustad (PhD Student, Norwegian University of Science and Technology)

Ms Lise Tuset Gustad (PhD Student, Norwegian University of Science and Technology)

Speaking to BJC Arrhythmia Watch, co-author Ms Lise Tuset Gustad (PhD Student, Norwegian University of Science and Technology) said: “Our study found a 32% increased risk for future AMI associated with severe depression symptoms and 26% increased risk associated with anxiety symptoms. For two repeated episodes of mixed anxiety and depression symptoms (MSAD), we saw a 52% increased risk of future first AMI. The depression and anxiety symptoms were self-reported using the Hospital Anxiety and Depression Scale, which measures loss of interest in usual activities (anhedonic depression) and anxiety.”

“We found some indications that the risk associated with depression  symptoms is larger in the first five years of follow up, possibly reflecting reverse causality. For example, unknown atherosclerosis could have been present at baseline and thus have caused both the depressive symptoms and the AMI,” she added.

“We did not study the effect of anti-depressants, but previous research on their role has not found convincing evidence for reduced risk of AMI. However, newer research with a multidisiplinary approach has shown promising results with individual tailored depression programmes including training, cognitive therapy and anti-depressants,” Ms Gustad added.

“For example, Stewart JC et al.2 treated diabetic patients for their depression before cardiovascular disease began, managing to reduce the risk of cardiovascular disease by 48%. There is effective treatment for depression, particularly if people get help early. Treatment is effective in increasing quality of life, and it may help the persons ability to take their medications as prescribed, stop smoking, improve their diet or exercise more,” Ms Gustad concluded.

References

1. Gustad LT, Laugsand LE, Janszky I, Dalen H, Bjerkeset O. Symptoms of anxiety and depression and risk of acutemyocardial infarction: the HUNT 2 study. Euro Heart J 2014;35:1394–403. http://dx.doi.org/10.1093/eurheartj/eht387

2. Stewart JC, Perkins AJ, Callahan CM. Effect of collaborative care for depression on risk of cardiovascular events: data from the IMPACT randomized controlled trial. Psychosom Med 2014;76:29–37. http://dx.doi.org/10.1097/PSY.0000000000000022

Published on: June 26, 2014

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  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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