Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events
Peter de Jonge1, Rob H S van den Brink, Titia A Spijkerman
1Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. p.de.jonge@med.umcg.nl
Insights
New depression after myocardial infarction (MI) increases cardiovascular event risk. Ongoing or recurrent depression post-MI does not significantly impact future cardiac events. Further subtyping of depression is recommended.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Post-myocardial infarction (MI) depression is a recognized complication.
- Depression following MI can be either a new episode (incident) or a continuation/recurrence of a previous episode (non-incident).
- The distinct prognostic implications of these depression subtypes after MI are not well understood.
Purpose of the Study:
- To investigate whether incident and non-incident depression after MI are differentially associated with future cardiovascular events.
- To compare the cardiovascular prognosis of patients with no depression, incident depression, and non-incident depression post-MI.
Main Methods:
- A cohort of 468 myocardial infarction (MI) patients were assessed for depressive disorders.
- Diagnostic assessment for depression followed the International Classification of Diseases-10 criteria within one year post-MI.
- Survival analysis was used to compare the incidence of new cardiovascular events over a mean follow-up of 2.5 years.
Main Results:
- Patients with incident depression post-MI showed a significantly increased risk of cardiovascular events (HR 1.65; 95% CI 1.02 to 2.65).
- Patients with non-incident depression post-MI did not have a statistically significant increased risk of cardiovascular events (HR 1.12; 95% CI 0.61 to 2.06).
- These findings persisted after controlling for potential confounding factors.
Conclusions:
- Only incident depression occurring after myocardial infarction (MI) is associated with a worse cardiovascular prognosis.
- The findings highlight the need for more detailed subtyping of post-MI depression.
- Future research should consider depression symptom profiles and personality traits to better understand cardiac outcomes.
Objectives:
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.
Background:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:14Myocarditis III: Medical Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
01:30Coronary Artery Disease III: Clinical Manifestations