title: Effect of collaborative care for depression on risk of cardiovascular events: data from the IMPACT randomized controlled trial.
abstract: OBJECTIVE
  Although depression is a risk and prognostic factor for cardiovascular disease (CVD), depression trials involving cardiac patients have not observed the anticipated cardiovascular benefits. To test our hypothesis that depression treatment delivered before clinical CVD onset reduces risk of CVD events, we conducted an 8-year follow-up study of the Indiana sites of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) randomized controlled trial.
  
  
  METHODS
  Participants were 235 primary care patients 60 years or older with major depression or dysthymia who were randomized to a 12-month collaborative care program involving antidepressants and psychotherapy (85 without and 35 with baseline CVD) or usual care (83 without and 32 with baseline CVD). Hard CVD events (fatal/nonfatal) were identified using electronic medical record and Medicare/Medicaid data.
  
  
  RESULTS
  A total of 119 patients (51%) had a hard CVD event. As hypothesized, the treatment × baseline CVD interaction was significant (p = .021). IMPACT patients without baseline CVD had a 48% lower risk of an event than did usual care patients (28% versus 47%, hazard ratio = 0.52, 95% confidence interval = 0.31-0.86). The number needed to treat to prevent one event for 5 years was 6.1. The likelihood of an event did not differ between IMPACT and usual care patients with baseline CVD (86% versus 81%, hazard ratio = 1.19, 95% confidence interval, 0.70-2.03).
  
  
  CONCLUSIONS
  Collaborative depression care delivered before CVD onset halved the excess risk of hard CVD events among older, depressed patients. Our findings raise the possibility that the IMPACT intervention could be used as a CVD primary prevention strategy.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01561105.
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St, LD 100E, Indianapolis, IN 46202. jstew@iupui.edu.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Stewart
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perkins
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003299:Cooperative Behavior; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: cerebrovascular disorders; coronary disease; depression; follow-up studies; prevention