Abstract
BackgroundDepressive symptoms is associated with adverse cardiovascular outcomes in patients with myocardial infarction (MI), but the underlying mechanisms are unclear and it remains unknown whether subgroups of patients are at a particularly high relative risk of adverse outcomes. We examined the risk of new cardiovascular events and/or death in patients with depressive symptoms following first-time MI taking into account other secondary preventive factors. We further explored whether we could identify subgroups of patients with a particularly high relative risk of adverse outcomes.Methods and ResultsWe conducted a prospective population-based cohort study of 897 patients discharged with first-time MI between 1 January 2009 and 31 December 2009, and followed up until 31 July 2012. Depressive symptoms were found in 18.6% using the Hospital Anxiety and Depression Scale (HADS-D≥8). A total of 239 new cardiovascular events, 95 deaths, and 288 composite events (239 new cardiovascular events and 49 deaths) occurred during 1,975 person-years of follow-up. Event-free survival was evaluated using Cox regression analysis. Compared to the 730 patients without depressive symptoms (HADS-D<8), the 167 patients with depressive symptoms (HADS-D≥8) had age- and sex-adjusted hazard ratios [HR] (95% confidence interval [CI]) of 1.53 (95% CI, 1.14–2.05) for a new cardiovascular event, 3.10 (95% CI, 2.04–4.71) for death and 1.77 (95% CI, 1.36–2.31) for a composite event. The associations were attenuated when adjusted for disease severity, comorbid conditions and physical inactivity; HR = 1.17 (95% CI, 0.85–1.61) for a new cardiovascular event, HR = 2.01 (95% CI, 1.28–3.16) for death, and HR = 1.33 (95% CI, 1.00–1.76) for a composite event. No subgroups of patients had a particularly high risk of adverse outcomes.ConclusionsDepressive symptoms following first-time MI was an independent prognostic risk factor for death, but not for new cardiovascular events. We found no subgroups of patients with a particularly high relative risk of adverse outcomes.
Highlights
Major depression following myocardial infarction (MI) affects 16% to 27% of patients within 2 weeks after MI [1]
We found no subgroups of patients with a high relative risk of adverse outcomes
Zuidersma et al [8] found that the association between post-MI depressive symptoms and new cardiovascular events or death was largely explained by cardiac disease severity, but they did not take into account physical activity, treatment of depression, or cardiac rehabilitation
Summary
Major depression following myocardial infarction (MI) affects 16% to 27% of patients within 2 weeks after MI [1]. In patients with stable coronary heart disease, Whooley et al [12] found that the association between depressive symptoms and new cardiovascular events or death was largely explained by health behavior, especially physical inactivity. Exercise may be just as effective at reducing depressive symptoms in patients with coronary heart disease as antidepressants [13], but it is unknown whether these results apply to patients with MI [8,12] It remains unknown whether subgroups of MI-patients with depressive symptoms are at a high risk of adverse outcomes and whether treatment of post-MI depression improves the adverse cardiovascular outcomes in these persons. Depressive symptoms is associated with adverse cardiovascular outcomes in patients with myocardial infarction (MI), but the underlying mechanisms are unclear and it remains unknown whether subgroups of patients are at a high relative risk of adverse outcomes. We further explored whether we could identify subgroups of patients with a high relative risk of adverse outcomes
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