Depression is a risk factor for mortality after myocardial infarction - Fact or artifact?

被引:46
作者
Dickens, Chris
McGowan, Linda
Percival, Carol
Tomenson, Barbara
Cotter, Lawrence
Heagerty, Anthony
Creed, Francis
机构
[1] Manchester Royal Infirm, Dept Cardiol, Manchester M13 9WL, Lancs, England
[2] Univ Manchester, Dept Psychiat, Psychol Med Res Grp, Manchester M13 9PL, Lancs, England
基金
英国医学研究理事会;
关键词
D O I
10.1016/j.jacc.2007.01.075
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
This study sought to investigate the long-term impact of depression on cardiac mortality after myocardial infarction (MI) and to assess whether the timing of depression influences the findings. Previous studies have shown that depression increases the risk of cardiac death after MI, although some studies with robust methodology have failed to show this effect. Clinical trials of depression treatments have failed to improve mortality. Until the relationship between depression and post-MI mortality is understood fully, clinical trials aimed at reducing mortality by treating depression remain premature. We recruited 588 subjects after MI and followed up their cases for up to 8 years. Patients underwent detailed assessments of cardiac status, conventional cardiac risk factors, and noncardiac illness at baseline. Depression was assessed for the period immediately preceding MI and at 12 months after MI, using a standardized questionnaire and a research interview. At follow-up, the mortality status, cause, and date of death were recorded for 587 subjects using population records. Multivariate predictors of cardiac death included older age (hazard ratio [HR] = 1.04, p = 0.007), previous angina (HR = 1.8, p = 0.03), previous MIs (HR = 1.6, p = 0.004), Killip class (HR = 1.8, p = 0.005), betablockers (HR = 0.5, p = 0.023), and angiotensin-converting enzyme inhibitors (HR = 0.6, p = 0.047) prescribed on discharge. Depression was not associated with cardiac mortality, whether detected immediately before MI (p = 0.48), 12 months after MI (p = 0.27), or at both time points (p = 0.97). The association between depression and post-Ml mortality is complex, possibly being limited to depression immediately after MI. Defining the window when intervention for depression might benefit survival is crucial for the design of future trials. (J Am Coll Cardiol 2007;49:1834-40) (C) 2007 by the American College of Cardiology Foundation.
引用
收藏
页码:1834 / 1840
页数:7
相关论文
共 38 条
[1]   DEPRESSED AFFECT, HOPELESSNESS, AND THE RISK OF ISCHEMIC-HEART-DISEASE IN A COHORT OF UNITED-STATES ADULTS [J].
ANDA, R ;
WILLIAMSON, D ;
JONES, D ;
MACERA, C ;
EAKER, E ;
GLASSMAN, A ;
MARKS, J .
EPIDEMIOLOGY, 1993, 4 (04) :285-293
[2]  
[Anonymous], COCHRANE DATABASE SY
[3]   DEPRESSION AND CARDIOVASCULAR-DISEASES [J].
AROMAA, A ;
RAITASALO, R ;
REUNANEN, A ;
IMPIVAARA, O ;
HELIOVAARA, M ;
KNEKT, P ;
LEHTINEN, V ;
JOUKAMAA, M ;
MAATELA, J .
ACTA PSYCHIATRICA SCANDINAVICA, 1994, 89 :77-82
[4]   Depression as a risk factor for mortality in patients with coronary heart disease: A meta-analysis [J].
Barth, J ;
Schumacher, M ;
Herrmann-Lingen, C .
PSYCHOSOMATIC MEDICINE, 2004, 66 (06) :802-813
[5]  
Berkman LF, 2003, JAMA-J AM MED ASSOC, V289, P3106
[6]   Depression, the autonomic nervous system, and coronary heart disease [J].
Carney, RM ;
Freedland, KE ;
Veith, RC .
PSYCHOSOMATIC MEDICINE, 2005, 67 :S29-S33
[7]  
Carney RM, 2006, J AM COLL CARDIOL, V44, P469
[8]   Definitions and distinctions among depressive syndromes and symptoms: Implications for a better understanding of the depression-cardiovascular disease association [J].
Davidson, KW ;
Rieckmann, N ;
Rapp, MA .
PSYCHOSOMATIC MEDICINE, 2005, 67 :S6-S9
[9]   Depression and social support in recovery from myocardial infarction: Confounding and confusion [J].
de Leon, CFM .
PSYCHOSOMATIC MEDICINE, 1999, 61 (06) :738-739
[10]   Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction [J].
Dickens, C. M. ;
Mcgowan, L. ;
Percival, C. ;
Tomenson, B. ;
Cotter, L. ;
Heagerty, A. ;
Creed, F. H. .
BRITISH JOURNAL OF PSYCHIATRY, 2006, 189 :367-372