Clinical InvestigationAcute Ischemic Heart DiseaseAnxiety disorders increase risk for incident myocardial infarction in depressed and nondepressed Veterans Administration patients
Section snippets
Background
Numerous epidemiological studies have established that depression is a risk factor for cardiovascular disease.1 Most studies have demonstrated that a history of depression increases the likelihood of incident heart disease, including myocardial infarction (MI), by approximately 2-fold.2, 3, 4, 5, 6 This effect remains after adjusting for common vulnerabilities including smoking, diabetes, and hypertension. Though less well studied, a growing literature has demonstrated that anxiety is a risk
Methods
We used a retrospective cohort design. Data were obtained from inpatient and outpatient International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses, Current Procedural Terminology codes, Pharmacy Benefits Management records and sociodemographic information maintained by the Veterans Health Administration (VHA) national medical care data sets beginning in Fiscal Year (FY) 1999, the first year that national data is considered complete. These data are
Patients with and without depression
The distributions of the covariates in the depressed and nondepressed groups are shown in Table I. Patients with depression were significantly younger at baseline as compared to nondepressed patients (51.6 vs 57.2 years, P < .0001). About 90% of the cohort were male but females were disproportionally over-represented among depressed patients (P < .0001). Depressed patients were more likely (P < .0001) to be white, not married, and to have only VA insurance coverage.
Compared to nondepressed
Discussion
In a cohort of patients receiving care in the VA medical system who were free of cardiovascular disease at baseline, we observed an increased risk for incident MI among patients with depression, anxiety disorder unspecified, GAD, panic disorder, and PTSD. In time-dependent adjusted analyses, anxiety disorder unspecified, panic disorder, and PTSD were significant predictors of MI in non-depressed; however, the effect of these anxiety disorders on risk of MI was attenuated among depressed
Acknowledgements
Dr Carney received an honorarium from Forest Laboratories, Inc, for participating in a symposium and completing a review of the literature concerning depression and heart disease. Dr Scherrer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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