Depression increases the onset of cardiovascular disease over and above other determinants in older primary care patients, a cohort study

Harm W. J. van Marwijk, Koen G. van der Kooy, Coen D. A. Stehouwer, Aartjan T. F. Beekman, Hein P. J. van Hout

To determine if major depressive disorder (MDD) in older primary care patients is an independent risk factor for cardiovascular events. A cohort of 143 primary care patients with depression and 139 non-depressed controls without depression (both aged over 55 years, matched for age and gender) from the Netherlands was evaluated for 2 years. MDD was diagnosed according to DSM-IV-criteria. During the follow-up period, information was collected on physical health, depression status and behavioural risk factors. CVD end points were assessed with validated annual questionnaires and were crosschecked with medical records. Thirty-four participants experienced a cardiovascular event, of which 71 % were depressed: 27/134 with MDD (20.1 %) and 9/137 controls (6.6 %). MDD was associated with a hazard ratio of 2.83 (p value 0,004, 95 % CI 1.32 to 6.05) for cardiovascular events. After adjustment for cardiovascular medication, the hazard ratio was 2.46 (95 % CI 1.14 to 5.30). In a 2 year follow-up period, baseline MDD increased the risk for CVD in older primary care patients compared with controls, over and above well-known cardiovascular risk factors.