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Depression confers risk for CVD in similar magnitude to obesity, high cholesterol in men
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According to new data, depressed mood and exhaustion pose as great a CVD risk in men as high cholesterol and obesity.
“There is little doubt that depression is a risk factor for [CVDs],” Karl-Heinz Ladwig, MD, group leader at the Institute of Epidemiology II at the Helmholtz Zentrum München, Neuherberg, Germany, professor of psychosomatic medicine at Technische Universität München’s Klinikum recths der Isar and scientist at Deutsches Zentrum für Herz-Kreislauf-Forschung, Munich, said in a press release. “The question now is: What is the relationship between depression and other risk factors like tobacco smoke, high cholesterol levels, obesity or hypertension — how big a role does each factor play?”
The researchers analyzed 3,428 patients aged 45 to 74 years who participated in one of three MONICA/KORA Augsburg surveys, conducted between 1984 and 1995, to investigate the comparison of the link between traditional somatic risk factors and depressed mood on all-cause mortality prediction and fatal CVD endpoints in an identical-source population.
In 10 years of follow-up covering 31,791 patient-years, 269 fatal CVD events and 557 cases of all-cause mortality were observed.
At baseline, 34% (n = 1,164) of participants experienced depressed mood and exhaustion.
Per 1,000 person-years, the absolute mortality risk for depressed mood and exhaustion was 23.1 cases for all-cause mortality and 11.2 cases for CVD mortality, Ladwig and colleagues wrote.
Depressed mood and exhaustion conferred elevated risk for all-cause and CVD mortality (HR = 1.52; P < .01 for both) at a magnitude higher than hypercholesterolemia and obesity but lower than hypertension, smoking and diabetes, according to the researchers.
Improvement in all-cause and CVD mortality risk prediction from depressed mood and exhaustion was similar to that from hypercholesterolemia and obesity, but substantially lower than that from hypertension, smoking and diabetes, Ladwig and colleagues wrote.
Depressed mood and exhaustion accounted for roughly 15% of the population-attributable risk for all-cause and CVD mortality, placing it around the middle among the classical risk factors, according to the researchers.
“Our data show that depression has a medium effect size within the range of major, non-congenital risk factors for [CVDs],” Ladwig said in the release. “In high-risk patients, the diagnostic investigation of comorbid depression should be standard. This could be registered with simple means.” – by Dave Quaile
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopBruce L. Rollman, MD, MPH
The findings in this paper are not surprising. There have been numerous papers published to describe the impact of co-morbid depression on mortality.
The researchers numerically quantified the risk of comorbid depression on mortality (both all-cause and CVD) in the context of widely accepted classical risk factors of diabetes, smoking, hypertension and hypercholesterolemia and they adjusted for these risk factors.
The strengths of the study are its size, enrollment of patients from 26 countries, and long-term follow-up (10 years). Weaknesses are that the study only included men, a big limitation; had a restricted age range (45 to 74 years); and lacked information on treatment for depression and CVD over the course of follow-up.
Many studies have documented a link between depression and adverse CV events, but we need more trials to examine the impact of treating depression on CV outcomes. We are conducting one such trial at our institution and should have results in late 2018.
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