Depression as a risk factor for ischaemic heart disease in men: population based case-control study

BMJ 1998;316:1714-1719 ( 6 June )

General Practice

Depression as a risk factor for ischaemic heart disease in men: population based case-control study

Julia Hippisley-Cox, lecturer in general practice, ^a Katherine Fielding, lecturer in medical statistics, ^b Mike Pringle, professor of general practice. ^a

^a Department of General Practice, The Medical School, Queen's Medical Centre, Nottingham NG7 2UH, ^b Trent Institute for Health Services Research, The Medical School, Queen's Medical Centre

Correspondence to: Dr Hippisley-Cox julia.h-cox{at}nottingham.ac.uk

Objective: To determine the relation between depression, anxiety, and use of antidepressants and the onset of ischaemicheart 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 to412 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 (adjusted2.75; 1.13 to 6.69; P=0.03). Men with depression within the preceding10 years were three times more likely to develop ischaemic heartdisease than were the controls (3.13; 1.27 to 7.70; P=0.01). Menwith ischaemic heart disease had a higher risk of subsequent ischaemicheart disease than men without ischaemic heart disease (adjusted2.34; 1.34 to 4.10; P=0.003). Depression was not a risk factorfor ischaemic heart disease in women on multivariate analysis(adjusted 1.34; 0.70 to 2.56; P=0.38). Anxiety and subsequentischaemic heart disease were not significantly associated in menor women.
Conclusion: Depression may be an independent risk factor for ischaemic heart disease in men, but not in women.

Key messages

So far, research into whether depression precedes myocardial infarction has been limited
This case-control study examined the relation between ischaemic heart disease and depression and the differences in this relation between men and women
Depression may be a risk factor for ischaemic heart disease in men but not women
This is independent of diabetes, hypertension, deprivation score, and smoking status

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