Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events

Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Journal of the American College of Cardiology (Impact Factor: 15.34). 01/2007; 48(11):2204-8. DOI: 10.1016/j.jacc.2006.06.077
Source: PubMed

ABSTRACT The purpose of this research was to study whether incident and non-incident depression after myocardial infarction (MI) are differentially associated with prospective fatal and non-fatal cardiovascular events.
Post-MI depression is defined as the presence of depression after MI. However, only about one-half of post-MI depressions represent an incident episode, whereas the other half are ongoing or recurrent depressions. We investigated whether these subtypes differ in cardiovascular prognosis.
A total of 468 MI patients were assessed for the presence of an International Classification of Diseases-10 depressive disorder during the year after index MI. A comparison was made on new cardiovascular events (mean follow up: 2.5 years) between patients with no, incident, and non-incident post-MI depression by survival analysis.
Compared with non-depressed patients, those with an incident depression had an increased risk of cardiovascular events (hazard ratio [HR] 1.65; 95% confidence interval [CI] 1.02 to 2.65), but not those with a non-incident depression (HR 1.12; 95% CI 0.61 to 2.06), which remained after controlling for confounders (HR 1.76; 95% CI 1.06 to 2.93 and HR 1.39; 95% CI 0.74 to 2.61, respectively).
Only patients with incident post-MI depression have an impaired cardiovascular prognosis. A more detailed subtyping of post-MI depression is needed, based on an integration of recent findings on the differential impact of depression symptom profiles and personality on cardiac outcomes.

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Available from: Johan Ormel, Jul 29, 2015
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    • "Several studies [17] [18] [19] [20] have reported that a depressive episode commencing after an acute coronary syndrome (ACS) hospitalization is associated with worse cardiovascular outcome, while other studies [21] [22] have found precoronary event depression to also be associated with poor cardiac prognosis. Regarding the impact of course of depressive symptoms on cardiac prognosis, evidence suggests that depressive symptoms post-MI, whether they persist or subside, are associated with worse cardiac prognosis [23]. "
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    • "Recurrent depression in ACS patients more likely resembles depression seen in the general population. Common risk factors for depression in the general population such as lower educational level and higher neuroticism are also seen in non-incident post-MI depressed patients (De Jonge et al., 2006.) Unlike ACS patients with incident depression, individuals with recurrent depression may experience an exacerbation of a previously existing vulnerability which is triggered by the ACS. "
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