title: Increased risk of myocardial infarction in depressed patients with type 2 diabetes.
abstract: OBJECTIVE
  To investigate major depressive disorder (MDD), which complicates the course of type 2 diabetes and is associated with an increased risk of cardiovascular disease and death. This risk may be due to a greater susceptibility for myocardial infarction (MI) in depressed patients with type 2 diabetes compared with nondepressed patients with type 2 diabetes.
  
  
  METHODS
  Veterans Administration electronic medical records were analyzed to identify a cohort free of cardiovascular disease in fiscal years 1999 and 2000, aged 25 to 80 years. ICD-9-CM codes were used to create a four-level risk group indicating 1) neither diabetes nor MDD (n = 214,749), 2) MDD alone (n = 77,568), 3) type 2 diabetes alone (n = 40,953), and 4) comorbid MDD and type 2 diabetes (n = 12,679). Age-adjusted Cox proportional hazards models were computed before and after adjusting for baseline sociodemographic and time-dependent covariates.
  
  
  RESULTS
  After adjusting for covariates, patients with type 2 diabetes alone and patients with MDD alone were at ∼30% increased risk for MI, and patients with type 2 diabetes and MDD were at 82% increased risk for MI (hazard ratio 1.82 [95% CI 1.69-1.97]) compared with patients without either condition.
  
  
  CONCLUSIONS
  Compared with patients with only diabetes or only MDD, individuals with type 2 diabetes and MDD are at increased risk for new-onset MI. Monitoring cardiovascular health in depressed patients with type 2 diabetes may reduce the risk of MI in this especially high-risk group.
authors.affiliation: St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA. scherrej@psychiatry.wustl.edu
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Garfield
authors.forename: Timothy
authors.initials: T
authors.lastname: Chrusciel
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hauptman
authors.forename: Robert M
authors.initials: RM
authors.lastname: Carney
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Freedland
authors.forename: Richard
authors.initials: R
authors.lastname: Owen
authors.forename: William R
authors.initials: WR
authors.lastname: True
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Lustman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models