This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wulsin, L. R. Articles by Benjamin, E. J. Search for Related Content PubMed PubMed Citation Articles by Wulsin, L. R. Articles by Benjamin, E. J. Related Collections Depression Coronary Artery Disease

Depressive Symptoms, Coronary Heart Disease, and Overall Mortality in the Framingham Heart Study

From the Departments of Psychiatry and Family Medicine, University of Cincinnati, Cincinnati, Ohio (L.R.W.); The National Heart, Lung, & Blood Institute's Framingham Heart Study, Framingham, Massachusetts (J.C.E., R.S.V., J.M.M., M.K.-H., E.J.B.); The Division of Cardiology & Preventive Medicine and Neurology, Boston Medical Center, Boston, Massachusetts (J.C.E., R.S.V., M.K.-H., E.J.B.); The Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts (J.M.M.).

Address correspondence and reprint requests to Lawson R. Wulsin, MD, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559. E-mail: Lawson.wulsin{at}uc.edu.

Objective: Although a substantial number of studies have shown that depressive symptoms predict worse cardiac outcome for patients with existing coronary disease, relatively few methodologically rigorous studies have examined the relation of depressive symptoms to coronary disease incidence in individuals initially free of heart disease in the community.

Methods: Using multivariable-adjusted sex-stratified Cox proportional hazards regression, we examined the association between depressive symptoms and incident coronary disease and all-cause mortality in 3634 Framingham Heart Study original and offspring cohort participants (mean age 52 years, 55% women) attending a routine study examination between 1983 and 1994.

Results: Over 6 years of follow-up, 83 participants had a hard coronary heart disease event (myocardial infarction or coronary death), and 133 died. Depressive symptoms (Center for Epidemiologic Studies Depression Scale (CES-D) 16) did not predict hard coronary disease events. All-cause mortality, however, was directly associated with depressive symptoms. Compared with the lowest tertile of CES-D score, multivariable-adjusted risks of death in the second and third tertiles were 33% and 88% higher, respectively (hazards ratio per tertile increment = 1.37, 95% confidence interval 1.10–1.71, p for trend = 0.005).

Conclusion: These findings underscore the importance of further research into the pathogenesis and prevention of excess mortality experienced with depressive symptoms.

Key Words: depressive symptoms • epidemiology • incidence • coronary heart disease • mortality • Framingham Heart Study

Abbreviations: 95% CI = 95% confidence interval; BMI = body mass index; CES-D = Center for Epidemiologic Studies Depression Scale; CHD = coronary heart disease; RR = relative risk.

This article has been cited by other articles:

				W. Lieb, A. S. Beiser, R. S. Vasan, Z. S. Tan, R. Au, T. B. Harris, R. Roubenoff, S. Auerbach, C. DeCarli, P. A. Wolf, et al. Association of Plasma Leptin Levels With Incident Alzheimer Disease and MRI Measures of Brain Aging JAMA, December 16, 2009; 302(23): 2565 - 2572. [Abstract] [Full Text] [PDF]

				J.-P. Zhang, B. Kahana, E. Kahana, B. Hu, and L. Pozuelo Joint Modeling of Longitudinal Changes in Depressive Symptoms and Mortality in a Sample of Community-Dwelling Elderly People Psychosom Med, September 1, 2009; 71(7): 704 - 714. [Abstract] [Full Text] [PDF]

				C. V. Igna, J. Julkunen, H. Vanhanen, P. Keskivaara, and M. Verkasalo Depressive Symptoms and Serum Lipid Fractions in Middle-Aged Men: Physiologic and Health Behavior Links Psychosom Med, November 1, 2008; 70(9): 960 - 966. [Abstract] [Full Text] [PDF]

				G. A. Wellenius, K. J. Mukamal, A. Kulshreshtha, S. Asonganyi, and M. A. Mittleman Depressive Symptoms and the Risk of Atherosclerotic Progression Among Patients With Coronary Artery Bypass Grafts Circulation, May 6, 2008; 117(18): 2313 - 2319. [Abstract] [Full Text] [PDF]

				W. F. Pirl, J. S. Temel, A. Billings, C. Dahlin, V. Jackson,, H. G. Prigerson, J. Greer, and T. J. Lynch Depression After Diagnosis of Advanced Non-Small Cell Lung Cancer and Survival: A Pilot Study Psychosomatics, May 1, 2008; 49(3): 218 - 224. [Abstract] [Full Text] [PDF]

				P. G. Surtees, N. W.J. Wainwright, R. N. Luben, N. J. Wareham, S. A. Bingham, and K.-T. Khaw Depression and Ischemic Heart Disease Mortality: Evidence From the EPIC-Norfolk United Kingdom Prospective Cohort Study Am J Psychiatry, April 1, 2008; 165(4): 515 - 523. [Abstract] [Full Text] [PDF]

				J. Ryan, I. Carriere, K. Ritchie, R. Stewart, G. Toulemonde, J.-F. Dartigues, C. Tzourio, and M.-L. Ancelin Late-life depression and mortality: influence of gender and antidepressant use The British Journal of Psychiatry, January 1, 2008; 192(1): 12 - 18. [Abstract] [Full Text] [PDF]

				K. J. Salaycik, M. Kelly-Hayes, A. Beiser, A.-H. Nguyen, S. M. Brady, C. S. Kase, and P. A. Wolf Depressive Symptoms and Risk of Stroke: The Framingham Study Stroke, January 1, 2007; 38(1): 16 - 21. [Abstract] [Full Text] [PDF]

				T. Darensburg, M. E. Andrew, T. A. Hartley, C. M. Burchfiel, D. Fekedulegn, and J. M. Violanti Gender and Age Differences in Posttraumatic Stress Disorder and Depression Among Buffalo Police Officers Traumatology, September 1, 2006; 12(3): 220 - 228. [Abstract] [PDF]