title: Symptoms of anxiety and depression and risk of heart failure: the HUNT Study.
abstract: OBJECTIVE
  Symptoms of anxiety and depression often co-exist with cardiovascular disease, yet little is known about the prospective risk for heart failure (HF) in people with symptoms of depression and anxiety. We aimed to study these prospective associations using self-reported symptoms of anxiety, depression, and mixed symptoms of anxiety and depression (MSAD) in a large population sample.
  
  
  RESULTS
  In the second wave of the Nord-Trøndelag Health Study (HUNT 2, 1995-1997), Norway, baseline data on symptoms of anxiety and depression, socio-demographic variables, health status including cardiovascular risk factors, and common chronic somatic diseases were registered for 62,567 adults, men and women, free of known HF. The cohort was followed for incident HF from baseline throughout 2008. A total of 1499 cases of HF occurred during a mean follow-up of 11.3 years (SD = 2.9), identified either in hospital registers or by the National Cause of Death Registry. There was no excess risk for future HF associated with symptoms of anxiety or MSAD at baseline. For depression, the multi-adjusted hazard ratios for HF were 1.07 (0.87-1.30) for moderate symptoms and 1.41 (1.07-1.87) for severe symptoms (P for trend 0.026). Established cardiovascular risk factors, acute myocardial infarction (AMI) prior to baseline, and adjustment for incident AMI as a time-dependent covariate during follow-up had little influence on the estimates.
  
  
  CONCLUSIONS
  Symptoms of depression, but not symptoms of anxiety or MSAD, were associated with increased risk for HF in a dose-response manner. The increased risk could not be fully explained by cardiovascular or socio-economic risk factors, or by co-morbid AMI.
authors.affiliation: Department of Internal Medicine, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway; Department of Neuroscience, Norwegian University of Technology and Science (NTNU), Trondheim, Norway.
authors.forename: Lise T
authors.initials: LT
authors.lastname: Gustad
authors.forename: Lars E
authors.initials: LE
authors.lastname: Laugsand
authors.forename: Imre
authors.initials: I
authors.lastname: Janszky
authors.forename: Håvard
authors.initials: H
authors.lastname: Dalen
authors.forename: Ottar
authors.initials: O
authors.lastname: Bjerkeset
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology*; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
keywords: Anxiety; Depression; Epidemiology; Heart failure; Prospective; Risk