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An attempt to explain the bidirectional association between ischaemic heart disease, stroke and depression: a cohort
Marie Kim Wium-Andersen1, Ida Kim Wium-Andersen2, Eva Irene Bosano Prescott3
1Post Doc, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.
Insights
Cardiovascular diseases (CVD) and depression are bidirectionally linked, with neither condition explained by shared risk factors, misclassification, or non-response. This highlights a complex relationship between heart health and mental well-being.
Area of Science:
- Cardiology
- Psychiatry
- Epidemiology
Background:
- Depression and cardiovascular diseases (CVDs) exhibit a well-documented bidirectional relationship.
- Understanding the underlying mechanisms of this association is crucial for public health.
Purpose of the Study:
- To investigate if shared risk factors, disease misclassification, or non-response could explain the bidirectional link between CVD and depression.
- To analyze the temporal association between cardiovascular events and the onset of depression.
Main Methods:
- Utilized data from 10 population-based cohorts (93,076 individuals) and the Metropolit study (10,510 men).
- Followed participants for subsequent diagnoses of depression, ischemic heart disease (IHD), and stroke using the Danish National Patient Registry.
- Employed Cox proportional hazard regression, treating diseases as time-dependent variables.
Main Results:
- Ischemic heart disease (IHD) and stroke were significantly associated with a subsequent diagnosis of depression (HRs ranging from 1.79 to 2.62).
- Depression was also associated with an increased risk of subsequent IHD and stroke (HRs 1.63 and 1.94, respectively).
- These associations remained robust after adjusting for shared risk factors and when using self-reported data or including non-responders.
Conclusions:
- The bidirectional association between CVD and depression is not attributable to shared risk factors, misclassification of disease, or participant non-response.
- The findings suggest a direct or unmeasured common pathway linking cardiovascular health and depression.
Background:
Depression and cardiovascular diseases (CVDs) are common diseases and associated in a bidirectional manner.
Aims:
To examine whether a bidirectional association between CVD and depression could be explained by shared risk factors, misclassification of disease measures or non-response.
Method:
A total of 10 population-based cohorts including 93 076 men and women (mean age 54.4 years, s.d. = 9.2) and an additional 10 510 men (mean age 51.2 years, s.d. = 0.3) were followed for subsequent depression, ischaemic heart disease (IHD) and stroke in the Danish National Patient Registry from health examinations between 1982 and 2015 and until end of follow-up in 2017-2018. Exposures were physicians' diagnoses of IHD, stroke, depression or self-reported chest pain, depression, use of antidepressant medication and the Major Depression Inventory at the time of study entry in the Metropolit study. Associations were analysed using Cox proportional hazard regression with disease as time-dependent variables.
Results:
IHD and stroke were associated with subsequent depression (hazard ratio (HR) for IHD: 1.79, 95% CI 1.43-2.23 and HR for stroke: 2.62, 95% CI 2.09-3.29) and the associations were present in both men and women. Adjustment for the shared risk factors socioeconomic status, lifestyle, body mass index, statin use and serum lipids did not change the risk estimates. Furthermore, depression was associated with higher risk of subsequent IHD (HR = 1.63, 95% CI 1.36-1.95) and stroke (HR = 1.94, 95% CI 1.63-2.30). The associations were also present when the analyses were based on self-reported disease measures or restricted to include non-responders.
Conclusions:
The bidirectional association between CVD and depression was not explained by shared risk factors, misclassification or non-response.
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