title: Combined effects of depressive symptoms and resting heart rate on mortality: the Whitehall II prospective cohort study.
abstract: OBJECTIVE
  To examine the combined effects of depressive symptoms and resting heart rate on mortality risk.
  
  
  METHODS
  Analysis was performed on data from 5,936 participants in the Whitehall II study with a mean ± SD age of 61 ± 6 years. Depressive symptoms were assessed from 2002 to 2004 using the Center for Epidemiologic Studies Depression Scale (cutoff score for depression at ≥ 16). Resting heart rate was measured at the same study phase via electrocardiogram. Participants were assigned to 1 of 6 risk-factor groups on the basis of depression status (yes/no) and resting heart rate categories (< 60, 60-80, and > 80 beats/minute [bpm]). All-cause mortality was the main outcome in our analysis. Mean follow-up for mortality was 5.6 years.
  
  
  RESULTS
  In mutually adjusted Cox regression models, depression (hazard ratio = 1.93, P < .001) and resting heart rate > 80 bpm (hazard ratio = 1.67, P < .001) were independent predictors of mortality. After adjustment for potential confounding and mediating variables, participants with both depression and high resting heart rate had a 3-fold higher (P < .001) risk of death compared to depression-free participants with resting heart rates ranging from 60 to 80 bpm. This risk is particularly marked in participants with prevalent coronary heart disease.
  
  
  CONCLUSIONS
  This study provides evidence that the coexistence of depressive symptoms and elevated resting heart rate is associated with substantially increased risk of death compared to those without these 2 factors. This finding suggests the possibility that treatments that improve both depression and resting heart rate might improve survival.
authors.affiliation: INSERM, U.1018, Center for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Bâtiment 15/16, 16 avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France. Hermann.Nabi@inserm.fr
authors.forename: Hermann
authors.initials: H
authors.lastname: Nabi
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Empana
authors.forename: Séverine
authors.initials: S
authors.lastname: Sabia
authors.forename: Annie
authors.initials: A
authors.lastname: Britton
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shipley
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology / Q000523:psychology; D003863:Depression / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors