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. 2010 Oct;96(20):1645-50.
doi: 10.1136/hrt.2010.198507. Epub 2010 Sep 15.

Effects of depressive symptoms and coronary heart disease and their interactive associations on mortality in middle-aged adults: the Whitehall II cohort study

Hermann Nabi  1 , Martin J Shipley, Jussi Vahtera, Martica Hall, Jyrki Korkeila, Michael G Marmot, Mika Kivimäki, Archana Singh-Manoux
Affiliations

Effects of depressive symptoms and coronary heart disease and their interactive associations on mortality in middle-aged adults: the Whitehall II cohort study

Hermann Nabi et al. Heart. 2010 Oct.

Abstract

Background: Depression and mortality have been studied separately in patients with coronary heart disease (CHD) and in populations healthy at study inception. This does not allow comparisons across risk-factor groups based on the cross-classification of depression and CHD status.

Objective: To examine effects of depressive symptoms and CHD and their interactive associations on mortality in middle-aged adults followed over 5.6years.

Design and setting: A prospective population-based cohort study of 5936 middle-aged men and women from the British Whitehall II study. We created four risk-factor groups based on the cross-classification of depressive symptoms and CHD status.

Results: The age-adjusted and sex-adjusted hazard ratios for death from all causes were 1.67 (p<0.05) for participants with only CHD, 2.10 (p<0.001) for those with only depressive symptoms and 4.99 (p<0.001) for those with both CHD and depressive symptoms when compared to participants without either condition. The two latter risk-factor groups remained at increased risk after adjustments for relevant confounders. The relative excess risk due to the interaction between depressive symptoms and CHD for all-cause mortality was 3.58 (95% CI -0.09 to 7.26), showing some evidence of an additive interaction. A similar pattern was also observed for cardiovascular death.

Conclusions: This study provides evidence that depressive symptoms are associated with an increased risk of all-cause and cardiovascular death and that this risk is particularly marked in depressive participants with co-morbid CHD.

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Conflict of interest statement

DECLARATION OF INTERESTS: None.

Figures

Figure 1
Figure 1
Hazard ratios of mortality for participants with both CHD and depressive symptoms comparatively to those with depressive symptoms but without CHD A: All-cause mortality B: Cardiovascular mortality
Figure 2
Figure 2
Hazard ratios of mortality for participants with both CHD and depressive symptoms comparatively to those with CHD but without depressive symptoms C: All-cause mortality D: Cardiovascular mortality
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