Depression and History of Attempted Suicide as Risk Factors for Heart Disease Mortality in Young Individuals

Abstract

Context Although depression is associated with increased cardiovascular morbidity and mortality, there is virtually no information on whether it also increases the risk in young populations. Objectives We sought to determine the association of unipolar and bipolar depression and a history of attempted suicide with mortality due to ischemic heart disease (IHD) and cardiovascular disease (CVD) in young US adults and to examine potential sex differences. Design Longitudinal epidemiologic study. Setting Nationally representative sample of US adults. Participants A total of 7641 US adults aged 17 to 39 years from the 1988–1994 Third National Health and Nutrition Examination Survey. Main Outcome Measures Cardiovascular disease and IHD mortality. Unipolar/bipolar depression and a history of attempted suicide were assessed via the Diagnostic Interview Schedule. Results After a median follow-up of 14.9 years, a total of 51 subjects (0.67%) died of CVD causes and 28 (0.37%) died of IHD. Depression (538 individuals [7.04%]) and history of attempted suicide (419 [5.48%]) were each associated with an increased risk of IHD death, with adjusted hazard ratios of 3.70 (95% CI, 1.32–10.35) for depression and 7.12 (2.67–18.98) for a history of attempted suicide. Women with depression or a history of attempted suicide had a 3-fold adjusted risk of CVD (adjusted hazard ratio, 3.20 [95% CI, 1.12–9.17]) and a 14-fold adjusted risk of IHD (14.57 [2.65–80.10]). Corresponding figures for men were 2.37 (0.85–6.58) and 3.52 (1.05–11.76). Conclusion In adults younger than 40 years, depression and history of attempted suicide are significant independent predictors of premature CVD and IHD mortality in both sexes.

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease

“…Indeed, the study that yielded the strongest data used the most rigorous assessment of mood (ie, diagnostic interviews) and the most valid cardiovascular outcome (ie, CVD mortality). 37 In a previous meta-analysis, the relative risk of incident CVD in adults conferred by diagnoses of MDD (2.69; 95% CI 1.63-4.43) was meaningfully stronger than the relative risk conferred by symptoms of depression (1.49; 95% CI 1.16-1.92). 46 These differences between diagnoses and symptoms are likely mediated by more severe, persistent, or recurrent elevations in pathophysiological processes discussed in the section "Pathophysiological Processes Bridging Mood Disorders and CVD."…”

“…First, the strongest evidence regarding these medications relates to increased CVD risk factors, and the best available evidence suggests that the association between mood disorders and CVD is independent of CVD risk factors. 37,46,258 Second, the association between mood disorders and excessive CVD risk was described decades before the advent of these medications. 11,14,259 Third, many if not most people in population-based studies on this topic had not received pharmacological treatment for their mood disorders.…”

“…The National Health and Nutritional Examination Survey included 7641 participants 17 to 39 years of age during 1988 to 1994 and performed follow-up of this cohort until 2006 (Table 2). 37 After controlling for Framingham scores, diagnoses of clinical depression, as opposed to high levels of mood symptoms on a checklist, were associated with increased ischemic heart disease (IHD) mortality. The adjusted hazard ratio for IHD mortality was 3.70 (95% confidence interval [CI] 1.32-10.35) for depression (associated with an MDD or BD diagnosis) and 7.12 (95% CI 2.67-18.98) for history of attempted suicide; associations were stronger among women.…”

Acute Myocardial Infarction in Women

“…177,178 Recent evidence suggests that depression in women is a powerful predictor of early-onset MI, showing a more robust association with MI and cardiac death in young and middle-aged women than in men of similar ages. 179 Compared with young men, young women with AMI in the VIRGO trial were more likely to have a history of depression. Even after adjustment for socioeconomic, clinical, and disease severity characteristics, young women with AMI had 60% greater odds of having significant depressive symptoms than young men.…”

Gender-Related Characteristics of Affective Disorders in Patients With Acute Myocardial Infarction

“…В общей популяции у женщин депрессия развивается примерно в 2 раза чаще, чем у мужчин [11], и является важным ФР ОИМ или сердечной смерти, увеличивая уровень риска для женщин примерно на 50 % [4][5][6][7][8][9][10][11][12]. Кроме того, депрессия у женщин является мощным предиктором раннего ОИМ, и связь депрессии с раз-витием ОИМ и сердечной смертью более выражена для женщин молодого и среднего возраста, чем для их ровесников-мужчин [13]. T. Rutledge и со-авт.…”