Abstract
Background: Associations between major depressive disorder (MDD) and coronary heart disease (CHD) have been established, and these associations increase risk of future morbidity and mortality. Prior research has been carried out in high-income countries. Here we examine associations between the mood and anxiety disorders, and CHD in a large cohort at baseline from Brazil, a country facing a variety of challenges that may affect these associations.Methods: Participants included 15,105 civil servants aged 35 to 74 at baseline (2008–2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CHD (N = 721) included self-reported angina pectoris (n = 305), myocardial infarction (n = 259) and coronary revascularization (n = 239). Hierarchical logistic regression analyses were conducted to estimate odds ratios and confidence intervals.Results: Major findings indicate that comorbid MDD and anxiety disorders (n = 434) are associated with a threefold increase in CHD, MDD alone (n = 170) with a twofold increase in CHD, while generalized anxiety disorder alone (n = 1,394) and mixed anxiety and depression disorder (n = 1,844) – symptoms present, but diagnostic threshold not reached – are associated with a 1.5-fold increase in CHD, after full adjustment for covariates.Conclusion: The association with CHD is greatest in those with psychiatric comorbidity, while associations were also observed in MDD and generalized anxiety disorder without comorbidity. While findings are limited by the cross-sectional design of the study, given the known risks associated with comorbidity of the mood and anxiety disorders with CHD, findings reinforce the importance of comprehensive health assessment in Brazil.
Highlights
Major depressive disorder (MDD) and coronary heart disease (CHD) are leading burdens of disease and the relationship between these disorders is bidirectional (Nemeroff and GoldschmidtClermont, 2012; Ramasubbu et al, 2012a; Stapelberg et al, 2012; Lichtman et al, 2014): many patients experience depression decades before CHD is manifest, while major depressive disorder (MDD) in patients with CHD is associated with increased morbidity and mortality
Major findings indicate that comorbid MDD and anxiety disorders (n = 434) are associated with a threefold increase in CHD, MDD alone (n = 170) with a twofold increase in CHD, while generalized anxiety disorder alone (n = 1,394) and mixed anxiety and depression disorder (n = 1,844) – symptoms present, but diagnostic threshold not reached – are associated with a 1.5-fold increase in CHD, after full adjustment for covariates
The association with CHD is greatest in those with psychiatric comorbidity, while associations were observed in MDD and generalized anxiety disorder without comorbidity
Summary
Major depressive disorder (MDD) and coronary heart disease (CHD) are leading burdens of disease and the relationship between these disorders is bidirectional (Nemeroff and GoldschmidtClermont, 2012; Ramasubbu et al, 2012a; Stapelberg et al, 2012; Lichtman et al, 2014): many patients experience depression decades before CHD is manifest, while MDD in patients with CHD is associated with increased morbidity and mortality. It remains unclear whether MDD, anxiety disorder or their comorbidity are most associated with CHD. We examine associations between the mood and anxiety disorders, and CHD in a large cohort at baseline from Brazil, a country facing a variety of challenges that may affect these associations
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