title: Association of anxiety disorders and depression with incident heart failure.
abstract: OBJECTIVE
  Depression has been associated with increased risk of heart failure (HF). Because anxiety is highly comorbid with depression, we sought to establish if anxiety, depression, or their co-occurrence is associated with incident HF.
  
  
  METHODS
  A retrospective cohort (N = 236,079) including Veteran's Administration patients (age, 50-80 years) free of cardiovascular disease (CVD) at baseline was followed up between 2001 and 2007. Cox proportional hazards models were computed to estimate the association between anxiety disorders alone, major depressive disorder (MDD) alone, and the combination of anxiety and MDD, with incident HF before and after adjusting for sociodemographics, CVD risk factors (Type 2 diabetes, hypertension, hyperlipidemia, obesity), nicotine dependence/personal history of tobacco use, substance use disorders (alcohol and illicit drug abuse/dependence), and psychotropic medication.
  
  
  RESULTS
  Compared with unaffected patients, those with anxiety only, MDD only, and both disorders were at increased risk for incident HF in age-adjusted models (hazard ratio [HR] = 1.19 [ 95% confidence interval {CI} = 1.10-1.28], HR = 1.21 [95% CI = 1.13-1.28], and HR = 1.24 [95% CI = 1.17-1.32], respectively). After controlling for psychotropics in a full model, the association between anxiety only, MDD only, and both disorders and incident HF increased (HRs = 1.46, 1.56, and 1.74, respectively).
  
  
  CONCLUSIONS
  Anxiety disorders, MDD, and co-occurring anxiety and MDD are associated with incident HF in this large cohort of Veteran's Administration patients free of CVD at baseline. This risk of HF is greater after accounting for protective effects of psychotropic medications. Prospective studies are needed to clarify the role of depression and anxiety and their pharmacological treatment in the etiology of HF.
authors.affiliation: MPH, Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660 South Euclid Ave, St Louis, MO 63110. garfiell@psychiatry.wustl.edu.
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Garfield
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hauptman
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Freedland
authors.forename: Tim
authors.initials: T
authors.lastname: Chrusciel
authors.forename: Sumitra
authors.initials: S
authors.lastname: Balasubramanian
authors.forename: Robert M
authors.initials: RM
authors.lastname: Carney
authors.forename: John W
authors.initials: JW
authors.lastname: Newcomer
authors.forename: Richard
authors.initials: R
authors.lastname: Owen
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Bucholz
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Lustman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016016:Proportional Hazards Models; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data
chemical_list: D011619:Psychotropic Drugs
keywords: administrative data; anxiety; depression; heart failure; medical records; psychotropic medication; veteran