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Depression as a risk factor for ischaemic heart disease in men: population based case-control study
J Hippisley-Cox1, K Fielding, M Pringle
1Department of General Practice, The Medical School, Queen's Medical Centre, Nottingham NG7 2UH. julia.h-cox@nottingham.ac.uk
Objective:
To determine the relation between depression, anxiety, and use of antidepressants and the onset of ischaemic heart disease.
Design:
Population based case-control study.
Setting:
All 5623 patients registered with one general practice.
Subjects:
188 male cases with ischaemic heart disease matched by age to 485 male controls without ischaemic heart disease; 139 female cases with ischaemic heart disease matched by age to 412 female controls.
Main Outcome Measure:
Adjusted odds ratios calculated by conditional logistic regression.
Results:
The risk of ischaemic heart disease was three times higher among men with a recorded diagnosis of depression than among controls of the same age (odds ratio 3.09; 95% confidence interval 1.33 to 7.21; P=0.009). This association persisted when smoking status, diabetes, hypertension, and underprivileged area (UPA(8)) score were included in a multivariate model (adjusted 2.75; 1.13 to 6.69; P=0.03). Men with depression within the preceding 10 years were three times more likely to develop ischaemic heart disease than were the controls (3.13; 1.27 to 7.70; P=0.01). Men with ischaemic heart disease had a higher risk of subsequent depression [corrected] than men without ischaemic heart disease (adjusted 2.34; 1.34 to 4.10; P=0.003). Depression was not a risk factor for ischaemic heart disease in women on multivariate analysis (adjusted 1.34; 0.70 to 2.56; P=0.38). Anxiety and subsequent ischaemic heart disease were not significantly associated in men or women.
Conclusion:
Depression may be an independent risk factor for ischaemic heart disease in men, but not in women.