Symptoms of anxiety and depression and risk of heart failure: the HUNT Study.
Bottom Line: For depression, the multi-adjusted hazard ratios for HF were 1.07 (0.87-1.30) for moderate symptoms and 1.41 (1.07-1.87) for severe symptoms (P for trend 0.026).Established cardiovascular risk factors, acute myocardial infarction (AMI) prior to baseline, and adjustment for incident AMI as a time-dependent covariate during follow-up had little influence on the estimates.The increased risk could not be fully explained by cardiovascular or socio-economic risk factors, or by co-morbid AMI.
Affiliation: Department of Internal Medicine, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway; Department of Neuroscience, Norwegian University of Technology and Science (NTNU), Trondheim, Norway.Show MeSH
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Mentions: Table2 presents the age- and sex-adjusted HRs and several multivariable adjusted HRs for incident HF in relation to symptoms of depression, anxiety, and MSAD. There was no excess risk for future HF associated with symptoms of anxiety in the crude model, adjusted for sex and age (HR 1.17, 95% CI 0.90–1.15). For MSAD, the moderately increased risk for HF observed in model 1 (HR 1.34, 95% CI 1.04–2.07) was explained by traditional cardiovascular factors in model 3 (HR 1.09, 95% CI 0.81–1.46). For depression, the age- and sex-adjusted HRs for HF were 1.11 (0.95–1.30) for moderate symptoms and 1.46 (1.19–1.80) for severe symptoms (P for trend 0.000). These associations for severe symptoms were only slightly attenuated after further adjustments for socio-economic status, an established cardiovascular risk factor (HR 1.37, 95% CI 1.04–1.81). Additional adjustment for previous and time-dependent incident AMI during follow-up did not further attenuate the risk for HF associated with severe symptoms of depression (HR 1.41, 95% CI 1.07–1.87). The results from the analysis using the risk per unit HADS score approach did not differ from the categorical approach; taking HADS-D as an example, with a 1.03 increased risk associated with each unit rise in HADS-D score, a person with a score of 8 will have 1.039 times, i.e 30%, increased risk compared with a person that scores 0. Figure2 shows the Kaplan–Meier curves for incident HF according to depression symptom categories; depressive symptoms were associated with higher risk for HF in a dose–response manner consistently during the follow-up.
Affiliation: Department of Internal Medicine, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway; Department of Neuroscience, Norwegian University of Technology and Science (NTNU), Trondheim, Norway.