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Depression and Cardiac Function in Patients With Stable Coronary Heart Disease: Findings From the Heart and Soul Study

From the VA Palo Alto Health Care System (H.L.), Palo Alto, California; VA Medical Center (S.A.&M.W.), San Francisco, California; and the Departments of Medicine, Epidemiology and Biostatistics (M.W.), University of California, San Francisco, California.

Address correspondence and reprint requests to Mary Whooley, Veterans Affairs Medical Center and University of California, San Francisco, 4150 Clement Street (111A1), San Francisco, CA 94121. E-mail: mary.whooley{at}ucsf.edu

Objective: To determine whether depression is associated with worse cardiac disease severity in patients with stable coronary heart disease (CHD). There is considerable evidence that depression is a risk factor for adverse cardiovascular events in patients with CHD. However, a frequent criticism of this literature is that the association between depression and adverse cardiovascular outcomes may be confounded by worse baseline cardiac disease severity in depressed patients.

Method: In a sample of 1020 outpatients with stable CHD, we examined the association between major depression (assessed using the Computerized National Institute of Mental Health Diagnostic Interview Schedule) with measures of cardiac disease severity, including systolic dysfunction, diastolic dysfunction, exercise-induced ischemia, and cardiac wall motion abnormalities. Cross-sectional univariate and multivariate models controlling for demographic and clinical variables were computed.

Results: Of the 1020 participants, 224 (22%) had current (past month) major depression. After adjustment for age, major depression was not associated with systolic dysfunction, diastolic dysfunction, inducible ischemia, or cardiac wall motion abnormalities. Similarly, multivariate models revealed no significant relationship between major depression and cardiac disease severity.

Conclusions: Overall, we found little evidence that depression is associated with worse cardiac disease severity. This suggests that greater baseline cardiac disease severity is unlikely to be responsible for the increased risk of CHD events in depressed patients.

Key Words: depression • cardiac function • coronary heart disease

Abbreviations: AMI = acute myocardial infarction; BMI = body mass index; CABG = coronary artery bypass graft; CDIS-IV = Computerized National Institute of Mental Health Diagnostic Interview Schedule; CHD = coronary heart disease; LVEF = left ventricular ejection fraction; PHQ-9 = Patient Health Questionnaire.