title: Depressive symptoms have an independent, gradient risk for coronary heart disease incidence in a random, population-based sample.
abstract: OBJECTIVE
  Depression is a risk factor for incident coronary heart disease (CHD), and predicts poor prognosis for patients post-myocardial infarction (MI). Few population-based, prospective studies have tested a gradient risk for depressive symptoms on CHD incidence.
  
  
  METHODS
  The sample (n=1302) was derived from the Nova Scotia Health Survey-1995 (NSHS95), an age- and sex-stratified, random, population-based health survey. All subjects were 45 years or older, free of overt CHD at baseline, and completed the Center for Epidemiological Studies-Depression (CES-D) scale. Covariates included age, sex, body mass index, physical activity level, family history of premature CHD, diastolic blood pressure, lipids, smoking, alcohol use, diabetes, and education level. For the 4 years following NSHS95, MI-related hospitalizations (ICD-9-CM code 410) and CHD-related deaths (ICD-9-CM codes 410-414) were extracted from the provincial, universal healthcare registry.
  
  
  RESULTS
  Fifty-two participants experienced a CHD event. A one standard-deviation increase in CES-D score was associated with a 1.32 hazard risk (confidence interval, 1.01-1.71) of CHD events, controlling for established CHD risk factors.
  
  
  CONCLUSIONS
  An independent, gradient association between depression and incident CHD was detected in a population-based sample with complete 4-year CHD data. This evidence supports the value of investigating mechanisms linking depression and CHD.
authors.affiliation: The Houston Veterans Affairs Medical Center, Veterans Affairs South Central Mental Illness Research, Education, and Clinical Centers, Houston, TX, USA. prowan@mdanderson.org
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Rowan
authors.forename: Donald
authors.initials: D
authors.lastname: Haas
authors.forename: John A
authors.initials: JA
authors.lastname: Campbell
authors.forename: David R
authors.initials: DR
authors.lastname: Maclean
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology*; D003863:Depression / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D012307:Risk Factors