Symptoms of anxiety and depression and risk of acute myocardial infarction: the HUNT 2 study.
OBJECTIVE
The nature of the association of depression and anxiety with risk for acute myocardial infarction (AMI) remains unclear. We aimed to study the prospective association of single and recurrent self-reported symptoms of anxiety and depression with a risk of AMI in a large Norwegian population based cohort.


RESULTS
In the second wave of the Nord-Trøndelag Health Study (HUNT2, 1995-97) baseline data on anxiety and depression symptoms, sociodemographic variables, health status including cardiovascular risk factors and common chronic disorders were registered for 57,953 adult men and women free of cardiovascular disease. The cohort was followed up during a mean (SD) 11.4 (2.9) years for a first AMI from baseline through 2008. A total of 2111 incident AMIs occurred, either identified at hospitals or by the National Cause of Death Registry. The multi-adjusted hazard ratios were 1.31 (95% CI 1.03-1.66) for symptoms of depression and 1.25 (CI 0.99-1.57) for anxiety. Two episodes of mixed symptoms of anxiety and depression (MSAD), reported 10 years apart, increased the risk for AMI by 52% (11-108%). After exclusion of the first 5 years of follow-up, the association of depression symptoms with AMI risk was attenuated. Relative risk for AMI with anxiety symptoms and MSAD weakened when participants with chronic disorders were excluded.


CONCLUSIONS
Self-reported symptoms of depression and anxiety, especially if recurrent, were moderately associated with the risk of incident AMI. We had some indications that these associations might partly reflect reverse causation or confounding from common chronic diseases.
Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Kirkegata 2, 7600 Levanger, Norway Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway lise.tuset.gustad@gmail.com lise.t.gustad@ntnu.no.
Lise Tuset
LT
Gustad
Department of Public Health and General Practice, NTNU, Trondheim, Norway Department of Internal Medicine, St Olavs hospital, Trondheim, Norway.
Lars Erik
LE
Laugsand
Department of Public Health and General Practice, NTNU, Trondheim, Norway Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Imre
I
Janszky
Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Kirkegata 2, 7600 Levanger, Norway MI Lab and Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.
Håvard
H
Dalen
Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Research and Development, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
Ottar
O
Bjerkeset
D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000523:psychology*; D009664:Norway / Q000453:epidemiology; D017678:Sex Distribution
Acute myocardial infarction; Anxiety; Depression; Epidemiology; Prospective; Risk