DEPRESSION AND LONG-TERM MORTALITY RISK IN PATIENTS WITH CORONARY-ARTERY DISEASE

Previous research has established that patients with coronary artery d isease (CAD) have an increased risk of death if they are depressed at the time of hospitalization. Follow-up periods have been short in thes e studies; therefore, the present investigation examined this phenomen on over an extended period of time, Patients with established CAD (n = 1,250) were assessed for depression with the Zung Self-Rating Depress ion Scale (SDS) and followed for subsequent mortality. Follow-up range d vp to 19.4 years. SDS scores were associated with increased risk of subsequent cardiac death (p = 0.002) and total mortality (p <0.001) af ter controlling for initial disease severity and treatment. Patients w ith moderate to severe depression had a 69% greater odds of cardiac de ath and a 78% greeter odds of mortality from all causes than nondepres sed patients, increased risk was not confined to the initial months af ter hospitalization. Patients with high SDS scores at baseline still h ed a higher risk of cardiac death >5 years later (p <0.005). Compared with the nondepressed, patients with moderate to severe depression had an 84% greater risk 5 to 10 years later and a 72% greater risk after >10 years. Patients with mild depression had intermediate levels of ri sk in all models. The heightened longterm risk of depressed patients s uggests that depression may be persistent or frequently recurrent in C AD patients and is associated with CAD progression, triggering of acut e events, or both.