DEPRESSION IS A RISK FACTOR FOR CORONARY-ARTERY DISEASE IN MEN - THE PRECURSORS STUDY

Background: Several studies have found that depression is an independe nt predictor of poor outcome after the onset of clinical coronary arte ry disease. There are few data concerning depression as a risk factor for the development of coronary artery disease. Objective: To determin e if clinical depression is an independent risk factor for incident co ronary artery disease. Patients and Methods: The Johns Hopkins Precurs ors Study is a prospective, observational study of 1190 male medical s tudents who were enrolled between 1948 and 1964 and who continued to b e followed up. In medical school and through the follow-up period, inf ormation was collected on family history, health behaviors, and clinic al depression. Cardiovascular disease end points have been assessed wi th reviews of annual questionnaires, National Death index searches, me dical records, death certificates, and autopsy reports. Results: The c umulative incidence of clinical depression in the medical students at 40 years of follow-up was 12%. Men who developed clinical depression d rank more coffee than those who did not but did not differ in terms of baseline blood pressure, serum cholesterol levels, smoking status, ph ysical activity, obesity, or family history of coronary artery disease . In multivariate analysis, the men who reported clinical depression w ere at: significantly greater risk for subsequent coronary heart disea se (relative risk [RR], 2.12; 95% confidence interval [CI], 1.24-3.63) and myocardial infarction (RR, 2.12; 95% CI, 1.11-4.06). The increase d risk associated with clinical depression was present even for myocar dial infarctions occurring 10 years after the onset of the first depre ssive episode (RR, 2.1; 95% CI, 1.1-4.0). Conclusion: Clinical depress ion appears to be an independent risk factor for incident coronary art ery disease for several decades after the onset of the clinical depres sion.