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General Practice

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

BMJ 1998; 316 doi: (Published 06 June 1998) Cite this as: BMJ 1998;316:1714
  1. Julia Hippisley-Cox, lecturer in general practice (julia.h-cox{at},
  2. Katherine Fielding, lecturer in medical statisticsb,
  3. Mike Pringle, professor of general practicea
  1. aDepartment of General Practice, The Medical School, Queen's Medical Centre, Nottingham NG7 2UH
  2. bTrent Institute for Health Services Research, The Medical School, Queen's Medical Centre
  1. Correspondence to: Dr Hippisley-Cox
  • Accepted 2 February 1998


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 ischaemic heart disease 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.

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


    • Accepted 2 February 1998
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