title: Depressive symptoms, coronary heart disease, and overall mortality in the Framingham Heart Study.
abstract: OBJECTIVE
  Although a substantial number of studies have shown that depressive symptoms predict worse cardiac outcome for patients with existing coronary disease, relatively few methodologically rigorous studies have examined the relation of depressive symptoms to coronary disease incidence in individuals initially free of heart disease in the community.
  
  
  METHODS
  Using multivariable-adjusted sex-stratified Cox proportional hazards regression, we examined the association between depressive symptoms and incident coronary disease and all-cause mortality in 3634 Framingham Heart Study original and offspring cohort participants (mean age 52 years, 55% women) attending a routine study examination between 1983 and 1994.
  
  
  RESULTS
  Over 6 years of follow-up, 83 participants had a hard coronary heart disease event (myocardial infarction or coronary death), and 133 died. Depressive symptoms (Center for Epidemiologic Studies Depression Scale (CES-D) > or =16) did not predict hard coronary disease events. All-cause mortality, however, was directly associated with depressive symptoms. Compared with the lowest tertile of CES-D score, multivariable-adjusted risks of death in the second and third tertiles were 33% and 88% higher, respectively (hazards ratio per tertile increment = 1.37, 95% confidence interval 1.10-1.71, p for trend = 0.005).
  
  
  CONCLUSIONS
  These findings underscore the importance of further research into the pathogenesis and prevention of excess mortality experienced with depressive symptoms.
authors.affiliation: Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio, USA. Lawson.wulsin@uc.edu
authors.forename: Lawson R
authors.initials: LR
authors.lastname: Wulsin
authors.forename: Jane C
authors.initials: JC
authors.lastname: Evans
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Murabito
authors.forename: Margaret
authors.initials: M
authors.lastname: Kelly-Hayes
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data