Coronary Artery Disease
Depression and the risk of coronary heart disease in the normative aging study

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Abstract

Increasing evidence supports an association between symptomatic depression and the risk of coronary heart disease (CHD), although no single study has compared multiple depression scales. We hypothesized that higher levels of symptomatic depression assessed from different depression scales were associated with the risk of CHD. We examined this relation in the Normative Aging Study, a prospective cohort of older men. A total of 1,305 men free of diagnosed CHD in 1986 completed the revised Minnesota Multiphasic Personality Inventory (MMPI-2). We categorized scores for the MMPI-2 D, MMPI-2 DEP, and Symptom Checklist-90 (SCL-90) depression scales. During an average 7.0 years of follow-up, 110 cases of incident CHD occurred, including 30 cases of nonfatal myocardial infarction, 20 cases of fatal CHD, and 60 cases of angina pectoris. Compared with men reporting the lowest level of depression, men in the highest level of depression had multivariate-adjusted relative risks of incident CHD (total CHD and angina) of 1.46 (95% confidence interval 0.83 to 2.57), 2.07 (95% confidence interval 1.13 to 3.81), and 1.73 (95% confidence interval 0.97 to 3.10) for the MMPI-2 D, MMPI-2 DEP, and SCL-90 scales, respectively. Similar RRs were obtained for each CHD subtype according to each depression scale. We found strong dose-response relations between level of depression measured by the MMPI-2 DEP scale and incidence of both angina pectoris (p value for trend, 0.039) and CHD (p value for trend, 0.016). Among older men, symptomatic depression measured by any of 3 depression scales may be positively associated with the risk of CHD.

Section snippets

Methods

The Normative Aging Study is a prospective study of aging established by the Veterans Administration in 1961. The study cohort consists of 2,280 community-dwelling men from the greater Boston area who were aged 21 to 80 years at the time of entry in 1961. Volunteers were screened at entry according to health criteria, and were free of known chronic medical conditions (including diabetes mellitus) at the start of follow-up.

Results

The mean (SD) depression scores for the MMPI-2 D, MMPI-2 DEP, and SCL-90 were 18.8 (4.9), 3.32 (4.1), and 0.31 (0.4), respectively. We found no significant differences in age, smoking status, systolic or diastolic blood pressure, body mass index, or family history of heart disease according to the level of depression for the MMPI-2 D scale (Table I). Subjects scoring ≤15 (the lowest category) on the MMPI-2 D scale had a mean cholesterol level of 250.9 mg/dl (44.0), greater than means of 245.4

Discussion

In this cohort of middle-aged and older men, we found a possible positive association between higher levels of depression—categorized by either the MMPI-2 D, MMPI-2 DEP, or SCL-90 scales—with both angina pectoris and all end points combined. Depression measured by both the MMPI-2 D and DEP scales may also be associated with an increased risk of total CHD and nonfatal myocardial infarction. Although these prospective data are based on relatively small numbers of CHD end points, our risk

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    This study was supported by Grants HL-54098, AG-02287, and by the Massachusetts Veterans Epidemiology Research and Information Center, Brockton/West Roxbury, Massachusetts.

    1

    Mr. Sesso is supported by Institutional Training Grant HL-07575 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

    2

    Dr. Kawachi is supported by a Career Development Award from the National Heart, Lung, and Blood Institute.

    3

    Dr. Sparrow is an Associate Research Career Scientist of the VA Medical Research Service.

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