Symptoms of depression causally linked to risk of coronary heart disease in UK

February 4, 2014

A report that will be published tomorrow provides strong evidence that the symptoms of depressive disorder are causally associated with the risk of coronary heart disease, and as such should be considered a potentially modifiable risk factor for the occurrence of CHD.

The findings, from the Whitehall II study of more than 10,000 civil servants in the UK, are published in the European Journal of Preventive Cardiology.

Findings from former studies on the association of with cardiovascular diseases are described by the investigators as "heterogeneous", with associations ranging from nil to strong. Among their explanations for the inconclusive results are bias because of "reverse causation" (by which vascular disease is the origin of the depression, not the consequence), and variability in the accuracy of "" in previous studies.

They thus write: "With repeated exposure measurements over a long period of adult life, causal inference would be strengthened if (a) reverse causation was excluded as an explanation for the link between and vascular events, and (b) a dose–response effect was evident." Both tests were applied in this study.

The Whitehall II study began in 1985-88 when the health of 10,308 working in 20 London-based departments was assessed by clinical examination and the 30-item General Health Questionnaire. Subsequent assessments were made every two-to-three years, with "exposure" to depression measured on six occasions over the 20-year study period. All participants were followed for major CHD events and stroke.

Results over the five-year observation cycles showed a cumulative effect of depressive symptoms on the risk of CHD consistent with an increasing dose-response. Thus, there was no added risk of CHD among those who showed evidence of depressive symptoms during one or two of the questionnaire assessments, but a 100% increase in risk in those who reported symptoms at three or four of the assessments.

However, the association of depressive symptoms with stroke was only apparent with short follow-up, suggesting that this association was an effect of reverse causation. "In other words," said investigator Dr Eric Brunner from the Department of Epidemiology and Public Health, University College London, UK, "depressive symptoms may be a sign of imminent stroke, but are not causally related." In addition, there was no evidence over the full study period of any dose-response effect with stroke. Both these findings, said Dr Brunner, suggest that in the case of stroke the depressive symptoms are a consequence of vascular disease, not its cause.

Thus, say the authors: "This finding provides evidence supporting a causal relationship between depression and CHD, in contrast to the findings in relation to stroke."

Dr Brunner adds: "European prevention guidelines refer to depression as a coronary risk factor, and in our study repeated episodes of depressive symptoms accounted for 10% of all CHD events in the study population. However, this figure relies on the strong assumption of a direct causal mechanism. Whether or not the association is causal, supporting individuals to recover from chronic or repeated episodes of depression has merit, particularly if the individual is then better able to reduce any vascular risk, for example by quitting smoking."

In considering an explanation for the different effect of depression on stroke and CHD risk, Dr Brunner proposed a possible effect of blood pressure. "Depressive symptoms have been linked with low ," he said, "and this linkage will tend to confound the association between depression and stroke." Blood pressure is particularly important for stroke risk, but is only one of several risk factors for CHD.

Explore further: Depression risk drops from pre- to post-final period

More information: Brunner EJ, Shipley MJ, Britton AR, et al. Depressive disorder, coronary heart disease, and stroke: dose–response and reverse causation effects in the Whitehall II cohort study. Eur J Prevent Cardiol 2014; DOI: 10.1177/2047487314520785

Related Stories

Depression risk drops from pre- to post-final period

November 14, 2013
(HealthDay)—There is a higher risk of depression before and a lower risk after the final menstrual period (FMP), according to a study published online Nov. 13 in JAMA Psychiatry.

Studies find new links between sleep duration and depression

January 31, 2014
A genetic study of adult twins and a community-based study of adolescents both report novel links between sleep duration and depression. The studies are published in the Feb. 1 issue of the journal Sleep.

Depressive symptoms linked to adult-onset asthma in African-American women

January 21, 2014
According to a new study from the Slone Epidemiology Center (SEC) at Boston University, African-American women who reported high levels of depressive symptoms had a greater likelihood of adult-onset asthma compared to women ...

Risk table acts as depression crystal ball

January 10, 2014
A risk table comprising modifiable risk factors associated with depression may potentially help health practitioners to predict the probability of depressive symptoms in elderly men later in life, a new study has found.

Depressive symptoms tied to doubled risk for Crohn's

January 16, 2013
(HealthDay)—Depressive symptoms are associated with a two-fold increase in risk of Crohn's disease (CD) but not ulcerative colitis (UC), according to research published in the January issue of Clinical Gastroenterology ...

Physical inactivity after cardiac surgery linked with substantially higher risk of depression

December 19, 2013
New research indicates that inactive patients following cardiac surgery have a substantially higher risk of depression and that the number of patients suffering from depression after cardiac surgery is as high as 40%. Investigators ...

Recommended for you

Researchers investigate the potential of spider silk protein for engineering artificial heart

August 18, 2017
Ever more people are suffering from cardiac insufficiency, despite significant advances in preventing and minimising damage to the heart. The main cause of reduced cardiac functionality lies in the irreversible loss of cardiac ...

Lasers used to detect risk of heart attack and stroke

August 18, 2017
Patients at risk of heart attacks and strokes may be spotted earlier thanks to a diagnosis tool that uses near-infrared light to identify high-risk arterial plaques, according to research carried out at WMG, University of ...

How Gata4 helps mend a broken heart

August 15, 2017
During a heart attack, blood stops flowing into the heart; starved for oxygen, part of the heart muscle dies. The heart muscle does not regenerate; instead it replaces dead tissue with scars made of cells called fibroblasts ...

Injectable tissue patch could help repair damaged organs

August 14, 2017
A team of U of T Engineering researchers is mending broken hearts with an expanding tissue bandage a little smaller than a postage stamp.

'Fat but fit' are at increased risk of heart disease

August 14, 2017
Carrying extra weight could raise your risk of heart attack by more than a quarter, even if you are otherwise healthy.

Air pollution linked to cardiovascular disease; air purifiers may lessen impact

August 14, 2017
Exposure to high levels of air pollution increased stress hormone levels and negative metabolic changes in otherwise healthy, young adults in a recent study conducted in China. Air purifiers appeared to lessen the negative ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.