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QUARTERLY FOCUS ISSUE: PREVENTION/OUTCOMES: CLINICAL RESEARCH: CARDIOVASCULAR RISK

Early-Onset Depression, Anxiety, and Risk of Subsequent Coronary Heart Disease

37-Year Follow-Up of 49,321 Young Swedish Men

Imre Janszky, MD, PhD^_*,_*, Staffan Ahnve, MD, PhD^_*, Ingvar Lundberg, MD, PhD and Tomas Hemmingsson, PhD^_*

^_* Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Department of Medical Sciences, Uppsala University, Uppsala, Sweden

Manuscript received November 16, 2009; revised manuscript received February 16, 2010, accepted March 2, 2010.

^_* Reprint requests and correspondence: Dr. Imre Janszky, Department of Public Health Sciences, Karolinska Institutet, Norrbacka, 6th Floor, Karolinska University Hospital, SE-171 76 Stockholm, Sweden (Email: imre.janszky{at}ki.se).

Objectives: The purpose of this study was to investigate the long-term cardiac effects of depression and anxiety assessed at a young age, when reverse causation is not feasible.

Background: Most prospective studies found a relatively strong association between depression and subsequent coronary heart disease (CHD). However, almost exclusively, only middle-age or older participants were examined, and subclinical atherosclerosis might contribute to the observed association. The prospective association between anxiety and CHD was less evident in previous studies and has been subjected to similar methodological concerns on the possibility for a reverse causation.

Methods: In a nationwide survey, 49,321 young Swedish men, 18 to 20 years of age, were medically examined for military service in 1969 and 1970. All the conscripts were seen by a psychologist for a structured interview. Conscripts reporting or presenting any psychiatric symptoms were seen by psychiatrists. Depression and anxiety was diagnosed according to International Classification of Diseases-8th Revision (ICD-8). Data on well-established CHD risk factors and potential confounders were also collected (i.e., anthropometrics, diabetes, blood pressure, smoking, alcohol consumption, physical activity, socioeconomic position, family history of CHD, and geographic area). Participants were followed for CHD and for acute myocardial infarction for 37 years.

Results: Multiadjusted hazard ratios associated with depression were 1.04 (95% confidence interval [CI]: 0.70 to 1.54), 1.03 (95% CI: 0.65 to 1.65), for CHD and for acute myocardial infarction, respectively. The corresponding multiadjusted hazard ratios for anxiety were 2.17 (95% CI: 1.28 to 3.67) and 2.51 (95% CI: 1.38 to 4.55).

Conclusions: In men, aged 18 to 20 years, anxiety as diagnosed by experts according to ICD-8 criteria independently predicted subsequent CHD events. In contrast, we found no support for such an effect concerning early-onset depression in men.

Key Words: anxiety • coronary heart disease • depression

Abbreviations and Acronyms   AMI = acute myocardial infarction   CHD = coronary heart disease   CI = confidence interval   ICD-8 = International Classification of Diseases-8th Revision

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