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The relationship between depression, anxiety and cardiovascular disease: findings from the Hertfordshire Cohort Study
Richard I G Holt1, David I W Phillips, Karen A Jameson
1Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK. R.I.G.Holt@soton.ac.uk
Insights
Depressive and anxiety symptoms are linked to cardiovascular disease (CVD). In men, depressive symptoms independently predict CVD, mortality, and cardiovascular mortality, highlighting the importance of mental health in cardiovascular outcomes.
Area of Science:
- Cardiology
- Psychiatry
- Epidemiology
Background:
- Previous research indicates a connection between depression, anxiety, and cardiovascular disease (CVD).
- This study investigates the relationship between depressive and anxiety symptoms and CVD in a population-based cohort.
Purpose of the Study:
- To determine the association between depressive symptoms (using the HAD-D scale) and anxiety symptoms (using the HAD-A scale) and cardiovascular disease (CVD).
- To assess whether these symptoms are independent predictors of CVD events and mortality.
Main Methods:
- The Hertfordshire Cohort Study included 1578 men and 1417 women.
- Cardiovascular disease (CVD) was assessed at baseline and after approximately 6 years.
- Depressive and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale (HADS).
Main Results:
- Higher baseline depressive symptom scores (HAD-D) were associated with increased odds of CVD in both men and women, and with specific cardiovascular risk factors.
- Anxiety symptoms (HAD-A) were associated with increased CVD in men only.
- High depressive symptom scores predicted incident CVD, all-cause mortality, and cardiovascular mortality in men, but not in women.
Conclusions:
- Depressive and anxiety symptoms are more prevalent in individuals with CVD.
- These symptoms, particularly depression, are independent predictors of CVD in men.
- While depressive symptoms correlate with cardiovascular risk factors, they do not fully account for the observed association with CVD.
Background:
Previous studies suggest a link between depression, anxiety and cardiovascular disease (CVD). The aim of the study was to determine the relationship between depressive and anxiety symptoms and CVD in a population based cohort.
Methods:
In total 1578 men and 1,417 women from the Hertfordshire Cohort Study were assessed for CVD at baseline and after 5.9 ± 1.4 years. Depressive and anxiety symptoms were measured using the HADS scale.
Results:
Baseline HAD-D score, but not HAD-A, was significantly associated with baseline plasma triglycerides, glucose and insulin resistance (men only) and HDL cholesterol (women only). After adjustment for CVD risk factors, higher baseline HAD-D scores were associated with increased odds ratios for CVD (men: 1.162 [95% CI 1.096-1.231]; women: 1.107 [1.038-1.181]). Higher HAD-A scores associated with increased CVD in men only. High HAD-D scores predicted incident CVD (adjusted OR 1.130 [1.034-1.235]), all-cause mortality (adjusted HR 1.081, [1.012-1.154]) and cardiovascular mortality (adjusted HR 1.109 [1.002-1.229]) in men but not in women.
Limitations:
The use of a self-report measure of depressive and anxiety symptoms, 'healthy' responder bias and the low number of cardiovascular events are all limitations.
Conclusions:
Depressive and anxiety symptoms are commoner in people with CVD. These symptoms are independent predictors of CVD in men. Although HAD-D score was significantly associated with several cardiovascular risk factors, this did not fully explain the association between HAD-D and CVD.
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