Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events

• Published in: Journal of the American College of Cardiology 2006-12, Vol.48 (11), p.2204-2208
• Main Authors: de Jonge, Peter, van den Brink, Rob H.S., Spijkerman, Titia A., Ormel, Johan
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Adult and adolescent clinical studies; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Confidence intervals; Coronary heart disease; Depression; Depressive Disorder - complications; Depressive Disorder - epidemiology; Depressive Disorder - etiology; Disabled Persons; Educational Status; Emotions; Female; Heart; Heart attacks; Humans; Incidence; Male; Medical prognosis; Medical sciences; Mental depression; Middle Aged; Miscellaneous; Mood disorders; Mortality; Myocardial Infarction - complications; Myocardial Infarction - physiopathology; Myocardial Infarction - psychology; Myocardial Infarction - therapy; Myocardial Revascularization; Myocarditis. Cardiomyopathies; Neurotic Disorders - complications; Personality; Personality traits; Prognosis; Proportional Hazards Models; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Stroke Volume; Studies; Survival analysis; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2006.06.077

Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events Peter de Jonge, Rob H. S. van den Brink, Titia A. Spijkerman, Johan Ormel About one-half of the depressions after myocardial infarction (MI) represent incident episodes, whereas the other half were present already before the MI. We investigated whether these subtypes differ in the occurrence of prospective cardiovascular events with a mean follow-up of 2.5 years. Incident depression was associated with an increased risk of cardiovascular events, but non-incident depression was not. A more detailed subtyping of post-MI depression is needed, based on an integration of recent findings on the differential impact of depression symptom profiles and personality on cardiac outcomes, to fully understand the association between depression and cardiovascular disease. The purpose of this research was to study whether incident and non-incident depression after myocardial infarction (MI) are differentially associated with prospective fatal and non-fatal cardiovascular events. Post-MI depression is defined as the presence of depression after MI. However, only about one-half of post-MI depressions represent an incident episode, whereas the other half are ongoing or recurrent depressions. We investigated whether these subtypes differ in cardiovascular prognosis. A total of 468 MI patients were assessed for the presence of an International Classification of Diseases-10 depressive disorder during the year after index MI. A comparison was made on new cardiovascular events (mean follow up: 2.5 years) between patients with no, incident, and non-incident post-MI depression by survival analysis. Compared with non-depressed patients, those with an incident depression had an increased risk of cardiovascular events (hazard ratio [HR] 1.65; 95% confidence interval [CI] 1.02 to 2.65), but not those with a non-incident depression (HR 1.12; 95% CI 0.61 to 2.06), which remained after controlling for confounders (HR 1.76; 95% CI 1.06 to 2.93 and HR 1.39; 95% CI 0.74 to 2.61, respectively). Only patients with incident post-MI depression have an impaired cardiovascular prognosis. A more detailed subtyping of post-MI depression is needed, based on an integration of recent findings on the differential impact of depression symptom profiles and personality on cardiac outcomes.